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This paper, taking the City of Hope National Medical Center as an example, introduces the application and admission of biomedical science doctors in the USA, analyzes the curriculum system and teaching patterns, elaborates the requirement of degree awarding, and compares the differences in postgraduate training system between China and the USA, thereby providing valuable experience and reference for training biomedical science postgraduate students with Chinese characteristics in the domestic universities.
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Objective:To analyze the correlation between saliva glucose and blood glucose level by measuring the concentration of saliva with high-precision ion chromatograph, and further to provide the clinical data for saliva glucose as an auxiliary index of blood glucose monitoring.Methods:A total of 268 subjects with normal glucose metabolism (NGT) and diabetes mellitus (DM) were enrolled and fasting venous blood and saliva samples were collected at the same time. The levels of saliva glucose, blood glucose and glycosylated hemoglobin (HbA1c) were measured by ion chromatograph, automatic biochemical analyzer and glycosylated hemoglobin analyzer, respectively. Methods of Kruskal-Wallis H test was used for comparison between groups, and the Spearman correlation was used for correlation analysis. Results:The mean values of blood glucose, saliva glucose and HbA1c in the DM group are all higher than those in the NGT group, and the differences are all statistically significant ( P<0.05). Saliva glucose cut-off points are set at 10, 15, 20 and 25 mg/L, respectively. When the saliva glucose concentration is greater than or equal to the above cut-off points, the saliva glucose level are positively correlated with the blood glucose level ( r=0.321, 0.379, 0.509 and 0.428, respectively, P<0.05) . Conclusion:The level of saliva glucose in DM is significantly higher than that in NGT. When the concentration of saliva glucose is greater than 20 mg/ L, there is a significant positive correlation between saliva glucose and blood glucose, and the max correlation coefficient r is 0.509.
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Elderly diabetic patients in China accounts for one fourth of the total number of elderly diabetic patients in the world, ranking the first worldwide. In 2021, National Center of Gerontology, Chinese Society of Geriatrics and Diabetes Professional Committee of Chinese Aging Well Association issued China′s first guideline on elderly diabetic patients——Guideline for the management of diabetes mellitus in the elderly in China (2021 edition). The present article interprets parts of the important recommendations of the guideline, aiming to facilitate its implementation in clinical practice effectively and improve the clinical prognosis of elderly diabetic patients in our country.
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Objective:To investigate the pathogenesis of Cushing′s syndrome induced by medullary thyroid carcinoma.Methods:Started from April 2011 to present, three medullary thyroid carcinoma patients with Cushing′s syndrome were enrolled in this study. All patients were 40 to 50 years old, one female and two males. The blood pressure, blood glucose, thyroid function and antibodies, calcitonin, and carcinoembryonic antigen(CEA)were detected. The qualitative and localized diagnosis of Cushing′s syndrome was performed by high- and low-dose dexamethasone suppression tests as well as imaging examinations. The biopsies of all patients were taken to test the immunostaining of calcitonin, adrenocorticotropin(ACTH), and corticotropin-releasing hormone(CRH).Results:According to the clinical manifestation and function tests, three patients were diagnosed as medullary thyroid carcinoma accompanied by ACTH-dependent Cushing′s syndrome. All patients showed positive immunohistochemical staining of calcitonin and CRH, with negative immunostaining of ACTH in one and positive immunostaining of ACTH in two patients. Therefore, the diagnosis of ectopic CRH syndrome caused by medullary thyroid carcinoma was definite.Conclusions:Medullary thyroid carcinoma is a rare cause of Cushing′s syndrome. Tumor cells secrete ACTH and CRH, which in turn cause hypercorticoremia. Ectopic CRH syndrome is very rare. Early diagnosis can be made by immunohistochemical staining of biopsy tissues to guide early targeted treatment and improve the prognosis.
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Objective:The aim of this study was to investigate the relationship between monocyte to high density lipoprotein-cholesterol ratio (MHR) and the infection, severity, and prognosis of diabetic foot ulcer.Methods:A retrospective cohort study of 194 patients with diabetic foot ulcer between September 2016 and August 2018 was conducted at the First Affiliated Hospital of University of South China. The clinical data, glucose and lipids metabolism, renal function, nutritional status, coagulation function, and severity of infection, severity, ischemic, and diagnosis were recorded. The rates of healed ulcer, amputation, and mortality were followed for six months.Results:The higher MHR levels of diabetic foot ulcer patients were accompanied with the higher Wagner grade, infection grade, severity of lower extremity ischemia, and proportion of adverse outcomes ( P trend<0.05). MHR and many traditional risk factors of diabetic foot ulcer (white blood cell count, C-reactive protein, albumin, estimated glomerular filtration rate, and ankle brachial index) were significantly correlated (all P<0.05). After adjustment for potential confounders, multivariate logistics regression analysis showed that MHR levels were positively associated with the occurrence of adverse outcomes [odds ratio ( OR) for the highest quartile vs lowest quartile, 1.52 (95% CI 1.08-3.08), P<0.05]. The receiver operating characteristic (ROC) curve analysis showed that area under the curve (AUC) of high MHR, high C-reactive protein, and low albumin for predicting the occurrence of adverse outcomes in diabetic foot ulcer patients were 0.674 (95% CI 0.581-0.747), 0.703(95% CI 0.615-0.772), and 0.667(95% CI 0.569-0.734), respectively. Conclusion:Elevation of MHR in diabetic foot ulcer patients are positively correlated with the grading of Wagner classification, and the severity of infection and ischemia, and seriously affects the prognosis of patients, suggesting that more attention should be paid to the MHR.
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Objective@#To explore the relationship between serum C1q and tumor necrosis factor related protein 6(CTRP6) level and insulin resistance in patients with newly diagnosed type 2 diabetes mellitus (T2DM).@*Methods@#A total of 167 patients with newly diagnosed T2DM in the outpatient department of our hospital were recruited from April 2016 to March 2017 and 165 subjects with normal glucose tolerance were used as the control group. The concentrations of CTRP6, interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor α (TNF-α) were determined by ELISA.@*Results@#Circulating CTRP6 level was significantly higher in T2DM group than that in control group [(652.54±132.57) vs (521.28±119.93)μg/L, P<0.01] after adjusting age and body mass index (BMI). Overweight/obese subjects revealed higher CTRP6 levels compared with those in lean individuals. In addition, circulating CTRP6 level was positively correlated with BMI, waist circumference, fasting plasma glucose, postprandial 2h plasma glucose, HbA1C, fasting insulin, homeostasis model assessment insulin resistance index (HOMA-IR), triglyceride (TG), IL-6, MCP-1, highly sensitive C-reactive protein (hs-CRP), and TNF-α, while it was inversely correlated with high-density lipoprotein-cholesterol(P<0.01). Multivariate linear regression analysis showed that TG, HOMA-IR, and IL-6 were independent factors for CTRP6 level. After adjusting for potential confounders, CTRP6 remained an independent risk factor for T2DM. Trend test showed that the increase in CTRP6 level was significantly linear with the occurrence of T2DM. The analysis of receiver operating characteristic curves revealed that the area under the curve for circulating CTRP6 to predict T2DM was 0.730.@*Conclusions@#CTRP6 may be associated with insulin resistance.
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Objective To explore the relationship between serum C1q and tumor necrosis factor related protein 6 ( CTRP6 ) level and insulin resistance in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods A total of 167 patients with newly diagnosed T2DM in the outpatient department of our hospital were recruited from April 2016 to March 2017 and 165 subjects with normal glucose tolerance were used as the control group. The concentrations of CTRP6, interleukin 6 (IL-6), monocyte chemoattractant protein-1 ( MCP-1), and tumor necrosis factor a( TNF-α) were determined by ELISA. Results Circulating CTRP6 level was significantly higher in T2DM group than that in control group [(652.54 ± 132.57) vs ( 521.28 ± 119.93) μg/L, P＜0.01] after adjusting age and body mass index (BMI). Overweight/obese subjects revealed much higher CTRP6 levels compared with those in lean individuals. In addition, circulating CTRP6 level was positively correlated with BMI, waist circumference, fasting plasma glucose, postprandial 2h plasma glucose, HbA1C, fasting insulin, homeostasis model assessment insulin resistance index ( HOMA-IR), triglyceride ( TG), IL-6, MCP-1, highly sensitive C-reactive protein ( hs-CRP ), and TNF-α, while it was inversely correlated with high-density lipoprotein-cholesterol ( P＜0.01). Multiple linear regression analysis showed that TG, HOMA-IR, and IL-6 were independent factors for CTRP6 level. After adjusting for potential confounders, CTRP6 remains an independent risk factor for T2DM. Trend detection showed that the increase in CTRP6 level was significantly linear with the occurrence of T2DM. The analysis of receiver operating characteristic curves revealed that the area under the curve for circulating CTRP6 to predict T2DM was 0.730. Conclusions CTRP6 may be associated with insulin resistance.
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Objective·To explore the biologic effect and mechanism of adenanthin (Aden) on multiple myeloma (MM) cells. Methods·MM cells, H929 and U266 were treated with various dose of Aden for different time, and the density and viability of MM cells were detected by trypan blue exclusion assay. After H929 and U266 cells were treated with various dose of Aden for 24 hours, cell growth inhibition was examined by CCK8 assay, and cell apoptosis was examined by AnnexinV-APC/PI staining assay. Apoptosis related proteins, NF-κB signaling pathway associated proteins and the NF-κB regulated proteins were detected by Western blotting. The effect of Aden on the thermal stability of IKKβ protein was determined by CETSA assay. Results·Trypan blue exclusion results showed that Aden inhibited cell growth and reduced cell viability in concentration and time dependent manners. U266 was more sensitive than H929 when exposed to the same concentration of Aden. The CCK8 results showed that Aden inhibited the growth of H929 and U266 cells in a concentration dependent manner. Flow cytometry results suggested that Aden induced a low apoptosis rate of MM cells. Moreover, cleavage of caspase3 and PARP were detected in U266 cells but not in H929 cells. CETSA assay indicated that Aden decreased the thermal stability of IKKβ. Expression of p-p65 and p-IκBα proteins decreased in MM cells treated with Aden. Conclusion·Aden significantly inhibits MM cell proliferation by inhibiting NF-κB activation through interacting with IKKβ. Aden has little effect on apoptosis of MM cells.
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[Summary] Next-generation sequencing is a revolution in the approach of genetic testing. It broadens the insight on the genetic diagnosis and research of monogenetic diabetes,which is represented by neonatal diabetes mellitus and maturity onset diabetes of the young.And it reveals advantages in exploring novel mutations.
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A 65-year-old male presented with recurrent palpitation and fatigue over one year. Lab tests revealed him with hyperinsulinaemic hypoglycemia. Insulin autoimmune antibody was repeatedly negative. Imaging of the pancreas seemed to be normal. Insulin-insulin autoimmune antibody complexes were detected by polyethylene glycol precipitation and gel filtration chromatography, thus the diagnosis of insulin autoimmune syndrome was suggested. By adjusting diet and administration of acarbose, all the symptoms were evidently relieved.
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A 65-year-old male presented with recurrent palpitation and fatigue over one year. Lab tests revealed him with hyperinsulinaemic hypoglycemia. Insulin autoimmune antibody was repeatedly negative. Imaging of the pancreas seemed to be normal. Insulin-insulin autoimmune antibody complexes were detected by polyethylene glycol precipitation and gel filtration chromatography, thus the diagnosis of insulin autoimmune syndrome was suggested. By adjusting diet and administration of acarbose, all the symptoms were evidently relieved.
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Objective To study the clinical characteristics of very elderly patients aged 80 years and over with diabetes mellitus (DM).Methods Clinical data of 95 very elderly patients with diabetes mellitus were retrospectively analyzed.Results Among 95 patients,patients with type 2 diabetes mellitus accounted for 98.9％ (94/95),patients with asymptomatic onset accounted for 35.8％ (34/95).The incidence of acute complications of diabetes mellitus was 11.6 ％ (11/95).Chronic complications of peripheral neuropathy and diabetic nephropathy were more common,and their incidences were 83.2％ (79/95) and 45.3％ (43/95),respectively.The percentage of patients with multiple chronic complications was up to 45.3％ (43/95).The percentage of DM patients combined with hypertension,coronary heart disease,cerebral infarction,hyperlipidemia or cardiac valve calcification was 80.0％ (76/95),48.4％ (46/95),77.9％ (74/95),42.1％ (40/95)and 33.7％ (32/ 95),respectively.There were 29 patients (30.5％) with the simultaneous presence of DM,hypertension,cerebral infarction,coronary heart disease,and hyperlipidemia in a same patient.The proportion of DM patients with low serum albumin was 47.4％ (45/95),and the rate achieving the target low density lipoprotein level was only 35.8％ (34/95).In the treatment,67.4％ (64/95) of patients were treated with oral hypoglycemic agents combined with insulin injection.The incidence of hypoglycemia was 24.2％ (23/95),and 69.6％ (16/23) of them had no self-conscious hypoglycemic symptoms.Conclusions Chronic complications are common in elderly diabetes mellitus patients.The elderly DM patients are prone to have many complications at the same time,with a higher incidence of hypoglycemic value under 3.9 mmol/L and lower rate of hypoglycemic symptoms.
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Objective To investigate the status of glycemic control in a group of type 2 diabetes mellitus patients combined with pe-ripheral arterial disease before and after operation .Methods Patients with lower extremity arterial occlusive disease who were in charge in vascular surgery of Peking Union Medical College Hospital from 2002 to 2012 were involved .Type2 DM out patient without lower extremity arterial occlusive disease were involved as control .We measured blood pressure ,blood glucose and blood lipid .Fasting,2hPG and average plasma glucose of two groups patients were Compared ,at the same time we observed the difference of plasma glucose before and after operation.The Student′s t test and ANOVA analysis were used to compare the difference of before and after operation and between groups . Results Total of sixty DM patients with lower extremity arterial occlusive disease were involved ,and sixty five patients were involved in control group.There was no difference in age between two groups (65.8 ±8.9 vs 63.0 ±10.0years).The DM patients with lower extremity arterial occlusive disease had longer duration of DM (12.2 ±7.1 vs 7.7 ±5.9years).PAD group had higher fasting plasma glucose (8.3 ± 2.7 vs 7.7 ±2.3mmol/L),post breakfast and lunch plasma glucose (10.7 ±2.9 vs 9.0 ±2.4mmol/L,10.6 ±3.1 vs 8.9 ±4.1mmol/L) than control group .There was no significant difference in post dinner plasma glucose of two groups .Patients with PAD obtained a good plas-ma glucose after they made an operation but insulin Volume had no change ,which was as fasting plasma glucose (7.7 ±2.1 vs 6.8 ± 2.8mmol/L),breakfast (10.5 ±2.5 vs 8.5 ±3.4mmol/L),lunch(10.5 ±3.1 vs 8.7 ±3.8mmol/L)and average plasma glucose (9.6 ± 1.8 vs 8.2 ±2.9mmol/L).Post dinner plasma glucose had no difference in two groups .Conclusion Type 2 DM patients combined with lower extremity arterial occlusive disease had a longer duration of diabetes and higher plasma glucose .At the same,therapy and operation can improve blood glucose control .If a DM patient has a poor plasma glucose ,we should find its reason ,and deal with complication ,then plasma glucose can be controlled better .
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<p><b>OBJECTIVE</b>To investigate the cell proliferation and genome stability in workers with occupational exposure to diesel exhaust (DE).</p><p><b>METHODS</b>In 2012, 117 DE-exposed workers and 106 control workers were recruited by cluster sampling in this study. The demographic data were obtained by questionnaire survey. The airborne fine particle and enriched polycyclic aromatic hydrocarbons (PAHs) at different workplaces were collected and analyzed. The concentrations of main PAHs monohydroxy metabolites in the urine were determined by high performance liquid chromatography-mass spectrometry (LC-MS), which could reflect the internal exposure level of DE. The cell proliferation capacity and genome stability in the periphery lymphocytes of workers were evaluated by cytokinesis-block micronucleus (CBMN) cytome assay.</p><p><b>RESULTS</b>The concentrations (median (P5-P95)) of total PAHs monohydroxy metabolites in the urine of exposed group and control group were 12.96 (4.73-28.10), 4.76 (0.90-15.00) µg/L, respectively, and the exposed group was higher than that of controls (Z = -8.77, P < 0.001). The nuclear division index (NDI) of exposed group and control group was 1.68±0.13, 1.85±0.16, respectively, and the NDI of exposed group showed significantly decreased (t = 8.86, P < 0.001), while the genome instability index calculated by micronucleus, nuclear bridges and nuclear buds, of exposed group and control group was 13.27±6.26, 4.83±3.38, respectively, and the exposed group had statistically significant increase (Z = -10.08, P < 0.001). The tertiles of total PAHs monohydroxy metabolites in the urine were categorized into low, medium and high groups (<5.96, 5.96-12.46, >12.46 µg/L). With the NDI decreased, 1.81±0.17, 1.79±0.17, 1.68±0.14 (F = 13.14, P < 0.001), genome instability index began to increase 5.80±4.15, 9.97±7.14, 11.99±6.61 (/1 000), respectively (χ(2) = 36.74, P < 0.001). With the increase of total PAHs monohydroxy metabolites level in corresponding groups. In addition, the NDI was negatively correlated with the frequencies of micronucleus, nuclear bridges, nuclear buds and genome instability index, respectively, and the difference was statistically significant (P < 0.001).</p><p><b>CONCLUSIONS</b>DE exposure lead to inhibition of cell proliferation capacity and increase genome instability in the peripheral lymphocytes of occupational-exposed population, providing important clues and evidence for early biomarkers monitoring.</p>
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Humans , Biomarkers , Cell Proliferation , Chromatography, Liquid , Genomic Instability , Lymphocytes , Micronucleus Tests , Occupational Exposure , Particulate Matter , Polycyclic Aromatic Hydrocarbons , Surveys and Questionnaires , Vehicle Emissions , WorkplaceABSTRACT
Traditionally it has been widely accepted that our genes together with adult lifestyle factors determine our risk of developing noncommunicable diseases such as type 2 diabetes mellitus ,cardiovascular disease and obesity in lat-er life.Currently, there is substantial evidence that the early life environment plays a key role in determining our suscepti -ble to such diseases in later life .As an increased focus on the understanding of central insulin resistance , central nerve sys-tem plays an extremely important role in regulating the peripheral glucose homeostasis .Substantial studies have indicated that it may be regulated by epigenetic mechanisms .Epigenetics can be defined as the study of heritable changes in gene ex-pression that do not involve alterations in the DNA sequence .Epigenetic processes play a central role in regulating tissue specific gene expression and hence alterations in these processes can induce long -term changes in gene expression and me-tabolism which persist throughout the lifecourse .This review will focus on the epigenetic machanisms of central neuroregula-tion between early life environment and glucose metabolism in adulthood .
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Objective Maternal dietary modifications determine the susceptibility to metabolic diseases in adult life.However, whether maternal high-fat diet can induce early-onset aberrant glucose and lipid metabolism in offspring mice is less understood .Materials and Methods We examined the effects of feeding the pregnant mice with either a high fat diet or nornal chow diet throughout pregnancy and lactation on the glucose and lipid metabolism in their offsprings . Some glucose and lipid metabolism biomarkers and hepatic histology were analyzed .Results At weaning, for males of dams fed high-fat diet , they had heavier body weight , the blood glucose levels were significantly higher at 30 min ( P<0.001) and 60 min (P<0.01) after intraperitoneal glucose administration , and the AUC was also significantly larger (P=0.0016) and HOMA-IR was higher(P<0.05).For females of dams fed high-fat diet, they had higher blood glucose levels at 30 min ( P<0.01 ) after intraperitoneal glucose administration .No significant differences were observed of AUC and HOMA-IR.Both males and females of dams fed high-fat diet had elevated total cholesterol levels ( P<0.0001 and P=0.0004, respectively).Triglyceride levels showed no significant differences between the two groups of males and females . The offsprings of high-fat diet group indicated hepatic steatosis and there were no differences between males and females . Conclusions Maternal high fat diet during pregnancy and lactation can induce early -onset aberrant glucose and lipid me-tabolism in offspring mice , and the male offsprings are more prone to metabolic changes , such as obesity , glucose intoler-ance and insulin resistance .
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Chromium is an essential mineral that is thought to be necessary for normal glucose homeostasis. Numerous studies give evidence that chromium picolinate can modulate blood glucose and insulin resistance. The main ingredient of Tianmai Xiaoke (TMXK) Tablet is chromium picolinate. In China, TMXK Tablet is used to treat type 2 diabetes. This study investigated the effect of TMXK on glucose metabolism in diabetic rats to explore possible underlying molecular mechanisms for its action.
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Improving insulin resistance is the key to prevention and treatment of type 2 diabetes.Treatment aimed at insulin resistance can prevent type 2 diabetes in an earlier stage with a better effect, prevent the deterioration of β-cell function, and decrease the rate of the progression to atherosclerosis.
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Objective To investigate the current status of type 2 diabetic patients who failed to achieve the glycemic control target, and provide theoretic evidences for making corresponding strategies. Methods The 2 diabetic patients who failed to reach the glycemic target were recruited from 181 hospitals in 26 cities and received a standard questionnaire, the conditions of their blood glucose level, lifestyle intervention, blood sugar monitoring, and drug therapy were recorded. Totally 3 861 questionnaires with complete information were collected. And the causes which account for glycemic control status were analyzed. Results Among these patients, the mean HbA1c was 7.9%, the mean fasting plasma glucose was 8.2 mmol/L, and the mean postprandial plasma glucose was 11.5 mmol/L. Only 25.6% of patients take their diet control strictly as prescribed and 44. 5% of patients have little exercise. 35. 8% and 47.8% of patients did not monitor their fasting and postprandial plasma glucose,respectively. Glycemic control in the patients aged ＞ 60 years was similar to the younger patients, but the hypoglycemia incidence in the elder group reached 35.5%, which was higher than those in the other 2 groups (20.8% and 21.4%, both P＜0. 05 ). The proportion of patients with mono-therapy and combination therapy was 46. 1% and 51.7%, while the proportion with combination therapy rose in the patients aged ＞60 years (58.7%;Compared with the other age-groups, all P＜0.05 ). 75 % of patients have adjusted their drug administration regimen since initial treatment. Conclusions Inadequate or inappropriate drug therapy regimen is a major cause responsible for this poor glycemic control status. In addition, the unhealthy life styles, insufficient blood sugar monitoring, and poor compliance were also important causes. Thus, for these patients, it is necessary to further enhance patients' education, to improve life style intervention, as well as to select more effective, safer, and compliant drug therapy regimens. Finally, the glycemic control target for the elder patients should be more flexible.
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Today,more and more patients with diabetes are requiring surgical intervention.Not only the metabolic disturbance of carbohydrate will be aggravated by surgical stress,but also the risk of perioperative complications and mortality have been greatly increased in patients with diabetes.Therefore,a complete preoperative assessment and blood glucose management of preoperative,intraoperative,and postoperative periods are needed to get full assurance for diabetic patients to undergo surgery and to pass through the perioperative period smoothly.