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Objective:To compare the efficacy and safety of glucocorticoids (GCs), rituximab (RTX), and GCs combined with RTX in the treatment of active moderate-to-severe Graves′ ophthalmopathy (GO).Methods:A total of 42 patients with GO who were hospitalized in the Endocrinology Department of Jiangsu Integrated Traditional Chinese and Western Medicine Hospital from August 2017 to July 2019 were included and divided into GCs group (18 cases), RTX group (7 cases), GCs combined with RTX group (17 cases). Patients in the GCs group were received 500 mg intravenous methylprednisolone once a week for 6 weeks, followed by 250 mg intravenous methylprednisolone once a week for 6 weeks. In RTX group, patients were given intravenous RTX 100 mg every 2 weeks for 2 times. GCs combined with RTX group, i. e. RTX combined with methylprednisolone pulse therapy. At 12 and 24 weeks after treatment, CAS and NOSPECS classes were evaluated in each group. The altered course of thyroid stimulating receptor antibody were compared among the three groups. All adverse events were recorded.Results:The proportion of CAS decreased≥2 or total scores<3 points in the GCs, RTX and combined groups were 88.9%, 85.7% and 100%, with no statistical difference among the three groups ( P=0.321). At 24 weeks, CAS and NOSPECS classes decreased significantly in all three groups compared with those before treatment ( P<0.05). The reduction of CAS in the combined group was greater than in the GCs group (-3.12±1.02 vs -2.39±1.02, P=0.036) and RTX group (-3.12±1.02 vs -2.14±0.90, P=0.034). One patient in the combined group developed optic neuropathy at 24 weeks after treatment, all other patients had no severe adverse events. Conclusion:Low-dose RTX alone is not inferior to intravenous GCs in the treatment of active moderate to severe GO. GCs combined with RTX is more effective in improving patients′ CAS than either drugs alone.
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Objective:To evaluate the effect of short-term very low-calorie restriction(VLCR) on glycemic control in overweight/obese patients with type 2 diabetes, and to explore mechanisms through identifying markers of gut microbiota.Methods:This trial was conducted in 14 adult overweight/obese patients with type 2 diabetes. They received VLCR for 9 days in the hospital(calorie intake 300-600 kcal/d). Before and after VLCR, body weight(BW), waist circumference(WC), blood pressure(BP), and heart rate(HR) were measured, and body mass index(BMI) was calculated according to their height and weight. Fasting blood glucose(FBG), 2 h postprandial blood glucose(2hPBG), fasting insulin(FINS), triglycerides(TG), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), and low-density lipoprotein-cholesterol(LDL-C) were determined, and yielded the homeostasis model assessment for insulin resistance(HOMA-IR). Additional lab tests such as liver and kidney function and electrolytes were performed. The estimated glomerular filtration rate(eGFR) was calculated to evaluate renal function. All data were analyzed using the SPSS Sample Power software. Feces samples were collected before and after VLCR. Fecal samples were tested for microbial diversity using 16S rDNA technology. Professional software was used to analyze the differences of gut microbiota in feces before and after VLCR.Results:After 9 days of VLCR, BW, BMI, WC, BP, HR, FBG, 2hPBG, FINS, HOMA-IR, alkaline phosphatase, TG, and blood urea nitrogen of 14 overweight/obese patients with type 2 diabetes were significantly reduced( P<0.05). No effect was seen on serum alanine aminotransferase, aspartate amino transferase, gamma glutamyl transferase, TC, HDL-C, LDL-C, creatinine, eGFR, uric acid, albumin, calcium, and phosphorus( P>0.05). The gut microbiota diversity did not differ before and after VLCR. The abundance of Bacteroidetes increased significantly, and the Firmicutes/Bacteroidetes ratio decreased from 11.79 to 4.20. Between groups analysis showed the abundance of Parabacteroides distasonis increased significantly after VLCR. Conclusion:VLCR can improve body weight and glucose and lipid metabolism in overweight/obese patients with type 2 diabetes, with no serious adverse events. Parabacteroides distasonis may be a marker of VLCR.
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This study aimed at investigating the effects of Chinese herbal compound Qi Kui granules on urine protein and inflammatory markers in patients with type 2 diabetic nephropathy (DN) based on the treatment of regular western medication.A randomized,parallel controlled method was involved in the present trial,and patients diagnosed with type 2 DN were randomly divided into the Chinese herb group and the control group.Regular treatment of angiotensin Ⅱ receptor blocker (ARB) in western medicine was administered in the two groups with the additional treatment of Qi Kui granules for the Chinese herb group.All the patients revisited the doctor every 4 weeks during the observation period within a 12-week course of the observation.Urinary albumin to creatinine ratio (UACR),urinary albumin excretion rate (UAER) and inflammatory cytokines in the two groups were determined.As a result,seventy-two patients in aggregate were included in the study,while 32 patients of the control group and 31 patients of the Chinese herb group effectively accomplished the observation.After the 12-week treatments,UACR and UAER were significantly decreased in the two groups (P ＜ 0.01),while the efficacy of the Chinese herb group was better than that of the control group (P ＜ 0.05).Compared with the control group,the levels of serum IL-6,tumor necrosis factor α (TNF-α),transforming growth factor f1 (TGF-f1) and urinary monocyte chemoattractant protein (MCP-1) / Cr significantly decreased after the 12-week treatment (P ＜ 0.01).It was concluded that the Chinese herbal compound Qi Kui granules successfully mitigated proteinuria in DN patients.The improvement of glomerular inflammation for renoprotection should be the mechanism behind this.
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Objective Toinvestigate the related risk factors of newly diagnosed diabetes among residents aged over 40 years in Nanjing City , and to provide evidence for diabetes prevention. Methods The clinical data were collected from the diabetes epidemiologic investigation among residents aged 40 -79 years from 6 communities in Nanjing City. Univariate and multiple logistic regression analyses were performed to analyze the potential risk factors for newly diagnosed diabetes. Results The prevalence rate of new diagnosed diabetes from 8039 subjects was 10.87%. A higher prevalence rate of new diagnosed diabetes was found in male than that in female (13.15% vs. 9.74%, P < 0.01). Multiple logistic regression analyses revealed that the main risk factors for newly diagnosed diabetes were male, age, family history, body mass index (BMI) and less physical activity after adjusting other factors (adjusted OR 1.339-1.862, P < 0.05). Conclusions Male, age, family history, body mass index (BMI) and less physical activity may be the main risk factors for diabetes among residents in Nanjing City.
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Adding the qualification examination of rural general practicing assistant doctors conforms to the needs of the rural doctors practicing medicine according to law.It benefits to the progress of practicing physician and improves the rural doctors'quality.Meanwhile, it has great significance in standardized management and stabilize the rural doctors.The villages and towns examination of practicing assistant doctors'qualification examination as an exam-ple, current relevant laws and policies provided legal basis.Meanwhile, the object of policy implementation that rural doctors desire the policy.This three aspects make adding the qualification examination of rural general practicing as-sistant doctors is feasible.In order to guarantee the practicing physicians process of rural doctors, we should complete the current laws, regulations and policies.Enhancing general practitioners'training and medical professional training that aims at the examination of practicing doctors'qualifications.Establishing a reasonable compensation, old-age se-curity and other social security mechanism for rural general practicing assistant doctors.
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[Summary] The aim of this study was to investigate the changes of sex hormone in male patients with type 2 diabetes and complicated with non-alcoholi fattty liver disease (NAFLD),and to detect the characteristics of the metablic indexs.A total of 112 patients were enrolled and divided into NAFLD group (n =54) and non-NAFLD group (n =58).All patients were measured for waist circumference,body mass index,metablic index,sex hormone,and serum transaminase.Compared with non-NAFLD group,the levels of fasting blood glucose,2 hour postprandial blood glucose,HbA1C in NAFLD group were significantly elevated [(8.75 ± 2.58 vs 7.79 ± 1.89) mmol/L,(18.12 ± 3.95 vs 15.63 ± 3.89) mmol/L,(11.96 ±4.85 vs 10.05 ±4.15)％,all P＜0.05].In addition,total cholesterol,triglyceride,body mass index,fasting insulin,and postprandial insulin in NAFLD group were significantly elevated [(4.97± 1.02 vs4.15±0.92) mmol/L,(2.74±2.25 vs 2.01± 1.45)mmol/L,(27.34±3.93 vs 22.38±3.39) kg/m2,(9.62 ± 5.80 vs 6.18 ± 4.21) μIU/ml,(72.71 ± 109.70 vs 31.72 ± 42.27) μIU/ml,all P＜0.05];while the total testosterone and free testosterone were lowered dramatically[(14.18 ±6.39 vs 18.21 ±6.14) nmol/L,(0.32 ± ± 0.03 vs 0.39 ± 0.08) ng/dl,both P＜0.05].Male patients with type 2 diabetes mellitus complicated with NAFLD are more prone to have disturbance in the lipid metabolism and had larger percentages of obesity and with lower level of testesterone.
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[Summary] To determine how endocrinologists in China access and treat patients with Graves' orbitopathy (GO) and gain insight on how to make the management of this disease more uniform and standardized in the context that management of GO continues to be challenging.Based on the questionnaire used in the European survey on GO,a questionnaire in Chinese was drafted and circulated to the members of Chinese Society of Endocrinology (CSE).There were a total of 124 valid responders.The majority (94.4％) of the responders believe that a muhidisciplinary approaches for GO management is valuable.Over 80％ of the participants advocated the evaluation of exophthalmometry,vision,visual fields by perimetry,eye movements,fundoscopy,TSH receptor antibodies,thyroid function,and ultrasound.Steroids were preferred as the first-line therapy by 92.7％ of responders,among them,59.7％ choose intravenous route.The treatment strategy for GO with intravenous glucocorticoids therapy still remains debated.Antithyroid drugs were the most common choice (72.6％) for first-line therapy of thyrotoxicosis.Treatment options for GO were very similar among Chinese,Latin-American,and European responders,though radioactive iodine and surgical treatment were more often indicated in China.The appropriate treatment of the patient with GO is controversial even amongst thyroid specialists.Further training of clinicians,easier access of patients to specialist multidisciplinary centres,and the publication of practice guidelines may help improving the management of this condition in China.
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Objective To explore the effects of mental practice on upper extremity function after stroke. Methods Thirty sub-acute stroke patients were randomly divided into a treatment group ( n=15 ) and a control group (n=15). The patients in the control group were treated with conventional therapy. The patients in the treat-ment group were treated with motor imagery therapy in addition. All patients were assessed using the Fugl-Meyer mo-tor assessment (FMA) and the motor assessment scale (bIAS) before treatment and after 2, 4 and 8 weeks of treat-ment. Results After 2 weeks of treatment, average MAS scores in the treatment group improved significantly com-pared with before treatment, but there was no significant difference between the two groups. After 4 weeks, FMA and MAS scores in the two groups had improved, and the FMA scores in the treatment group were significantly higher than those of the control group. After 8 weeks, the FMA and MAS scores of both groups had further improved significant-ly, but the average FMA and MAS scores in the treatment group were now significantly higher than those in the control group. Conclusions Mental practice can improve the functional performance of the upper extremities of stroke pa-tients.
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Objective This paper investigated the effects of intermittent hypoxia exposure (IHE) on HRPRP?SOD?GSH-PX?MDA and exercise performance. Methods Fifteen male students were randomly assigned to group of control and IHE. The IHE group intermittently inhaled different hypoxic gas mixtures (O 2% were 14%, 12%, 10%, respectively),50～60 mins daily for 4 weeks. Both groups completed Bruce protocol exercise on the treadmill before and after IHE. The HRPRP, SOD, GSH-PX, MDA were measured at rest and post exercise respectively. Results The concentration of HRPRP and the activity of SOD, GSH-PX were increased as well as VO 2max and the time to exhaustion. Conclusion IHT is effective on improving the antioxidant capacity and sports performance.
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The superoxide anion radical (Of) produced in the alkaline dimethyl sulfoxide (DMSO) system was directly measured by electron paramagnetic resonance (EPR) at low temperature. This reaction was used as a model system for generating O2-. Astragalus membranaceus, Codonopsis pilousla, Paeonia laetiflora, Angelica sincnsis and Sophora flavescens, traditional natural medicines which have the effect of delaying anility, were added into the model system to observe their intensifying or inhibiting effect on EPR signals of O2. These results suggest that these traditional natural medicines have the mostly eliminating effect on Of produced in the alkaline DMSO system.
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The effects of qi-tonics and blood-activating decoction on acute myocardial infarction and ischemia-reperfusion induced arrhythmias were studied in anaesthetized open chest SD rats. Three days before coronary artery occlusion, the qi-tonics and blood-activating decoction was perfused into the stomach of the rats in the experimental group (10 ml/kg weight) once a day, and 4d later, the coronary artery was occluded in anaesthetized open chest rats. The results demonstrated that qi-tonics and blood-activating decoction could reduce significantly the incidence and severity of arrhythmias caused by myocardial infarction and ischemia-reperfusion. The qi-tonics and blood-activating decoction could decrease the amount of the superoxide anion radicals (O2-) produced in the alkaline dimethyl sulfoxide (DMSO) system measured by electron paramagnetic resonance (EPR) at low temperature. The effect of qi-tonics and blood-activating decoction on O2-may be one of the mechanisms for its antiarrhythmic effect during reperfusion.