Metabolic indicators associated with non-communicable diseases deteriorated in COVID-19 outbreak: evidence from a two-center, retrospective study

ObjectiveOur study aimed to investigate whether the metabolic indicators associated with non-communicable diseases (NCDs) in the general population have changed during the COVID-19 outbreak. METHODSThis retrospective self-controlled study enrolled adult participants with metabolic indicators relate to NCDs followed at Fujian Provincial Hospital and Fujian Provincial Hospital South Branch. The metabolic indicators followed during January 1, 2020 and April 30, 2020, the peak period of the COVID-19 epidemic in China, were compared with the baseline value in the same period last year. Pared-samples T-test and Wilcoxon signed-rank test were performed to analyze the differences between paired data. ResultsThe follow-up total cholesterol was significantly increased than that of the baseline (4.73 (4.05, 5.46) mmol/L vs 4.71 (4.05, 5.43) mmol/L, p=0.019; n=3379). Similar results were observed in triglyceride (1.29 (0.91, 1.88) vs 1.25 (0.87, 1.81) mmol/L, p<0.001; n=3381), uric acid (330.0 (272.0, 397.0) vs 327.0 (271.0, 389.0) umol/L, p<0.001; n=3364), and glycosylated hemoglobin (6.50 (6.10, 7.30) vs 6.50 (6.10, 7.20) %, p=0.013; n=532). No significant difference was observed in low density lipoprotein, body mass index and blood pressure. ConclusionsMetabolic indicators associated with NCDs deteriorated in the COVID-19 outbreak. We should take action to prevent and control NCDs without delay.

Thoughts on Higher Medical Education Under Major Public Health Emergencies: Thinking Ahead After COVID-19 Outbreak

ImportanceThe spread of coronavirus disease 2019 (COVID-19) has posed great threat to peoples health and several medical schools in the world suspended classes as a precaution against the virus. China has also adopted precautionary measures to keep medical schools running without suspending classes. Thinking ahead after COVID-19 Outbreak is important. ObjectiveTo explore the most suitable teaching and learning pattern in medical school during COVID-19 Outbreak. DesignThis study is a case-control study. We had tried to apply a new blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction to the students before the outbreak and then universities responded to the COVID-19 outbreak by closing campuses and shifting to other forms of distance learning. In other word, the courses started using blended teaching model before COVID-19 outbreak and might last using other forms of distance learning throughout the pandemic. Five Point Likert Scale Questionnaires which contains 20 items were used, and the effect of the two kinds of teaching patterns was compared by evaluating the indicators of core competencies of students including professionalism, attitude towards learning, knowledge and learning skills, teamwork skills, motivation in learning, adaptability and acceptance of the courses and network environment. SettingOur study based on a single center. ParticipantsFifty fourth-year medical students receiving the "5+3" pattern courses regarding internal medicine were enrolled in the study. Exposure(s) (for observational studies)The teaching and learning patter started using blended teaching model before COVID-19 outbreak and might last using other forms of distance learning throughout the pandemic. Main Outcome(s)According to the descriptive statistical analysis of the first part of the questionnaire (question 1-16), the average score of adaptability and acceptance of the courses is 2.60 lower than 3, indicating that students are more adapted to other forms of distance learning during COVID-19 outbreak; the average score of the rest of the questions is higher than 3, indicating that blended teaching model based on 5G network is superior to other forms of distance learning. The number of male students who are inclined to the blended teaching model based on 5G network is 0.13 times as much as that of female students (95%CI:0.028[~]0.602, p=0.009). ResultsOnline forms of distance learning were accepted by the students. Female students had higher expectations on the course and were more likely to adapt well to the change during the COVID-19 outbreak. However, all students preferred the blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction before the pandemic. ConclusionIt indicates that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students online. Chinas experience in online higher medical education may serve as a reference to other countries during the pandemic. Key pointO_ST_ABSQuestionsC_ST_ABSWhat are the reflections on approaches to teaching and learning during COVID-19 Outbreak? FindingsFifty fourth-year medical students receiving the "5+3" pattern courses regarding internal medicine were enrolled. Five Point Likert Scale Questionnaires which contains 20 items were used. This study indicates that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students online during COVID-19 outbreak. MeaningChinas experience in online higher medical education may serve as a reference to other countries during the pandemic.

Blood glucose levels in elderly subjects with type 2 diabetes during COVID-19 outbreak: a retrospective study in a single center

AimsIdeal glycemic control is of great importance for diabetic patients during public health emergencies of infectious diseases as long-term hyperglycemic are not only associated with chronic complications but also vital drivers of common and life-threatening infections. The present study was designed to investigate the changes of blood glucose levels in elderly subjects with type 2 diabetes(T2D) during COVID-19 outbreak. MethodsThis retrospective study focused on the T2D outpatients at Fujian Provincial Hospital aged 65 years old and above who received baseline test for fasting plasma glucose and/or glycated hemoglobin (HbA1c) between January 1, 2019 and March 8, 2019 and were followed up on fasting plasma glucose and/or HbA1c in the same period in 2020. The baseline and follow-up data were analyzed with the paired-samples T-test. ResultsA total of 135 elderly subjects with T2D with baseline and follow-up fasting plasma glucose and 50 elderly subjects with T2D with baseline and follow-up HbA1c were analyzed, respectively. The baseline and follow-up fasting plasma glucose were 7.08 {+/-} 1.80 and 7.48{+/-}2.14 mmol/L, respectively (P=0.008). The baseline and follow-up HbA1c were 7.2{+/-}1.7% and 7.4{+/-}1.8%, respectively (P=0.158). ConclusionsElderly subjects with T2D had higher fasting plasma glucose levels during COVID-19 outbreak. We should pay more attension to the management of diabetics during public health emergencies.

Epidemiological and clinical characteristics of SARS-CoV-2 and SARS-CoV: a system review

AbstractsO_ST_ABSImportanceC_ST_ABSIn 2002-2003, a severe pulmonary infectious disease occurred in guangdong, China. The disease was caused by severe acute respiratory syndrome coronavirus (SARS-CoV), 17 years apart, also happen in China, and also a novel coronavirus (SARS-CoV-2), this epidemic has posed a significant hazard to peoples health both China and the whole world. ObjectiveSummarized the latest epidemiological changes, clinical manifestations, auxiliary examination and pathological characteristics of COVID-19. Evidence ReviewPubMed database were searched from 2019 to 2020 using the index terms "novel coronavirus" or "COVID-19" or "2019-nCoV" or "SARS-CoV-2" and synonyms. Articles that reported clinical characteristics, laboratory results, imageological diagnosis and pathologic condition were included and were retrospectively reviewed for these cases. This paper adopts the method of descriptive statistics. Results34 COVID-19-related articles were eligible for this systematic review,Four of the articles were related to pathology. We found that Fever (86.0%), cough (63.9%) and Malaise/Fatigue (34.7%) were the most common symptoms in COVID-19. But in general, the clinical symptoms and signs of COVID-19 were not obvious. Compared with SARS, COVID-19 was transmitted in a more diverse way. The mortality rates of COVID-19 were 2.5%, and the overall infection rate of healthcare worker of COVID-19 was 3.9%. We also found that the pathological features of COVID-19 have greatly similar with SARS, which manifested as ARDS. But the latest pathological examination of COVID-19 revealed the obvious mucinous secretions in the lungs. InterpretationThe clinical and pathological characteristics of SARS and COVID-19 in China are very similar, but also difference. The latest finds of pathological examination on COVID-19 may upend existing treatment schemes, so the early recognition of disease by healthcare worker is very important. Key PointsO_ST_ABSQuestionC_ST_ABSWhat can we learn from the clinical manifestations and pathological features of 2019 novel coronavirus disease (COVID-19)? FindingsIn this review, we found COVID-19 was transmitted in a more diverse way than Severe acute respiratory syndrome (SARS). Fever, cough and Malaise/Fatigue were the most common symptoms. We also found that the SARS-CoV-2 has the same cell entry receptor ACE2 as SARS-CoV, and they have similar pathological mechanisms like Acute respiratory distress syndrome (ARDS). MeaningThis review aims to give people a more comprehensive understanding of COVID-19 and to continuously improve the level of prevention, control, diagnosis and treatment.

Pituitary abscess: Report of three cases / 中华内分泌代谢杂志

Pituitary abscess is a rare but potentially life-threatening disease. Headache, visual disturbance, and hypopituitarism are the most common presenting symptoms of pituitary abscess. On magnetic resonance imaging(MRI), pituitary abscess may present as a round sellar cystic lesion, hypo- or isointense on T1 imaging and hyper- or isointense on T2 imaging with peripheral gadolinium enhancement. Diagnosis usually is made during surgical exploration when pus is found in a cystic lesion. The mainstay of treatment is transsphenoidal surgical resection in combination with antibiotic therapy, although a craniotomy approach is warranted in select conditions. Here we report 3 cases of pituitary abscess in our hospital and review the literatures.

Approach to the patient with Klinefelter syndrome combined with neuropsychological abnormality / 中华内分泌代谢杂志

Klinefelter syndrome(KS) is the most common sex chromosome disorder in males,which is caused by the presence of the extra X chromosome that maybe inherited from mother or father. Approximately 80% karyotype of the cases is 47,XXY. KS is characterized by small firm testes, hypergonadotropic hypogonadism, infertility,gynaecomastia, increased height. However, cognitive disabilities and psychiatric disorders are rarely diagnosed in KS because they lack screening in related aspects. At the present, the pathogenesis of cognitive disabilities and increased risk of psychiatric diseases in KS have not been delineated. In this article,we report two cases of KS,and review their clinical manifestations,diagnosis,and treatments.

Progress in the effects and machanism of central regulation of energy metabolism by estrogen / 中华内分泌代谢杂志

Sex hormones such as estrogen in females may play prominent roles in the control of numerous physiological process including growth, development, reproduction, and metabolism.The effects of estrogen are receptor dependent.Estrogen receptor(ER)have two main forms,Erαand Erβ,which were widely distributed in the central and peripheral tissues.Recently,more and more data have shown that the central estrogen via ER play a critical role in the regulation of various biological effects including physiological and pathological process.This article will review the role of estrogen on energy metabolism,especially in hypothalamus,in order to find the target sites of the central estrogen responsible for the diseases related to reproduction and energy metabolism.

Approach to the patient with Kallmann syndrome / 中华内分泌代谢杂志

Kallmann syndrome ( KS) is a rare disease and characteristic of an absence of puberty, infertility, and a defective sensation of smell (anosmia or hyposmia). Here, we analyze the features of a case of KS diagnosed clinically. In addition, the etiology, genetic features, clinical manifestations, diagnosis, and treatment of KS were reviewed.

Progress in research of KISS1/KISS1R system and reproductive function / 中华内分泌代谢杂志

Kiss1 gene encodes Kisspeptins,an intercellular signal peptide whose corresponding receptor is Kiss1R. The initial study found that the Kiss1/Kiss1R system has the effect on inhibiting tumor metastasis. More and more evidence suggests that it can act on the hypothalamic-pituitary-gonadal(HPG) axis and is the key to puberty initiation and progression. It plays an important role in the neuroendocrine regulation of reproduction. In this paper, we reviewed the studies on Kiss1/Kiss1R system,its intracellular signal transduction pathway,role on HPG axis,and clinical application.

Kisspeptin-A new link bridging energy homeostasis and reproduction / 中华内分泌代谢杂志

[Summary] Kisspeptin is vital for the neuroendocrine regulation of GnRH secretion. Kisspeptin neurons are now recognized as a central pathway responsible for conveying key homeostatic information to GnRH neurons. A number of metabolic modulators have been proposed as regulators of kisspeptin including leptin, adiponectin, insulin, ghrelin, POMC, and neuropeptide Y. Recent data indicate that kisspeptin may have a direct role in regulating energy balance by its regulation of food intake and glucose homeostasis. Thus, kisspeptin may serve as a new connection between reproductive function and energy metabolism.

Association of napping and night-time sleep with impaired glucose regulation, insulin resistance and glycated haemoglobin in Chinese middle-aged adults with no diabetes: a cross-sectional study.

OBJECTIVE: To assess associations between napping and night-time sleep duration with impaired glucose regulation, insulin resistance (IR) and glycated haemoglobin (HbA1c). DESIGN: Cross-sectional study. SETTING: Fujian Province, China, from June 2011 to January 2012. PARTICIPANTS: This study enrolled 9028 participants aged 40-65 years. Data of 7568 participants with no diabetes were included for analysis. Type 2 diabetes was defined applying WHO criteria. OUTCOME MEASURES: Participants' daytime napping and night-time sleep duration data were collected using a standardised self-reported Chinese-language questionnaire about sleep frequency and quality. Anthropometric and laboratory parameters were also measured. IR was defined as a HOMA-IR index value >2.50. ORs and 95% CIs were derived from multivariate logistic regression models. RESULTS: Participants (mean age 51.1±7.0 years) included 3060 males and 4508 females with average night-time sleep of 7.9 h. A higher proportion of males napped than females. After adjustment for potential confounders, ORs for HbA1c >6.0% were 1.28 and 1.26 for those napping ≤1 h and >1 h (p=0.002 and p=0.018), respectively. Statistically significant differences in IR between nappers and non-nappers were only marginal clinically. Odds for HbA1c >6.0% were significantly lower in participants with longer night-time sleep durations than in the reference group (>8 h vs 6-8 h). Odds for IR were significantly lower in participants whose night-time sleep hours deviated from the reference group (<6 h, >8 h vs 6-8 h) CONCLUSIONS: Chinese middle-aged adults with no diabetes who napped had higher HbA1c and IR; those with shorter night-time sleep durations had increased HbA1c. Night-time sleep hours that are either <6 or >8 tend to be associated with lower odds for IR. Further studies are necessary to determine the underlying clinical significance and mechanisms behind these associations.

Associations of age at menarche and menopause with cardiovascular disease, diabetes, and osteoporosis / 中华内分泌代谢杂志

Menarche and menopause are two important physiological periods that denote the beginning and the end of normal reproductive life.Studies have suggested that ages at menarche and menopause are important biological markers,and are also predictors of several chronic diseases.We published one manuscript in J Clin Endocrinol Metab titled Associations between age at menarche and menopause with cardiovascular disease,diabetes,and osteoporosis in Chinese women,which suggested that ages at menarche and menopause are not associated with diabetes,delayed menarche and menopause are associated with decreased risk of cardiovascular disease risk and early menopause with high risk of osteoporosis.

AMP-activated protein kinase inhibits KiSS-1 gene expression through SP1 in the hypothalamic GT1-7 neurons / 中华内分泌代谢杂志

The effect of AMP-activated protein kinase (AMPK) on KiSS-1 mRNA levels was detected by realtime PCR in the hypothalamic GT1-7 neurons. The promoter activity of KiSS-1 gene was detected by DualLuciferase Reporter Assay System.The effects of AMPK on the protein expression and subcellular distribution of SP1 were determined by Western blot.The results showed that AMPK reduced the mRNA expression and promoter activity of KiSS-1 gene while SP1 increased the promoter activity of KiSS-1 gene. Besides,AMPK alse decreased the translocation of SP1.These results suggest that AMPK may inhibit the expression of KiSS-1 gene by decreasing the translocation of SP1 from cytoplasm to nucleus in the hypothalamus GT1-7 neurons.

The retrospective analysis of acute drug poisoning 744 cases in emergency center affiliated to general hospital / 中华急诊医学杂志

Objective To study the characteristics of epidemiology among the emergency patients with acute drugs poisoning in emergency center of Fujian Province.Methods Retrospective study was used to collect data of patients with acute drugs poisoning from 2004 to 2009,and data of patients 'gender,age,cause of poisoning,poison type,emergency diagnosis,medical treatment,etc.were analyzed.Results The epidemiological reports of 744 cases of acute drugs poisoning patients were collcected from 2004 to 2009,the male-to-female ratio was 1:4.2,the average age was 33.0,high incidence group was at ages 18 ～29 (50.3％ ).The most visiting time was in Spring (April to June).Eighty-eight point three percentage of poisoning was intentional.Central nervous system drugs,in particular sedative/hypnotic drugs (64.5％ )was the most common agents associated with poisoning.The poisoned patients were divided into three groups with mild ( 51.5％ ),moderate ( 33.2％ ) and severe ( 15.3％ ) according to the patient' s condition.Thirty-seven percentage poisoned patients were discharged after treatment followed up for observation,and 28.3％ patients were hospitalized,no patients died.Conclusions The majority of acute drugs poisoning among patients from city were sedative/hypnotic drugs.Reasonable grading and different treatment according to the condition of acute drugs poisoning would be helpful to improve the survival rates of acute poisoning and reduce medical costs.

Approach to the patients with Gitelman syndrome / 中华内分泌代谢杂志

Two patients with typical Gitelman syndrome were diagnosed by gene and their clinical data and endocrine and metabolic status were evaluated.The etiology,clinical manifestation,laboratory findings,genetic diagnosis,and treatment for Gitelman syndrome were reviewed.

Epidemiological analysis of acute poisoning in emergency center affiliated to general hospital / 中华急诊医学杂志

Objective Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China. Method We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients.Results Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratween 18 and 40 years old. The incidence of acute poisoning was as high as 11.33% in January each year. The incidence of poisoning was in a descending order: alcohol poisoning (54.55%), medication poisoning (25.95%), pesticide poisoning (5.65%), and drug poisoning (4.88%). Most (56.44%) of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning ( P ＜ 0.01 ). Approximately 69.54% of the patients were followed up after emergency treatment, 30.39% were hospitalized, and four patients died. Conclusions Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel "pre-hospital emergency care-emergency department-hospital treatment" can significantly improve the survival rate of patients with acute poisoning.