Association of Chronic Kidney Disease with Coronary Heart Disease and Stroke Risks in Patients with Type 2 Diabetes Mellitus: An Observational Cross-sectional Study in Hangzhou, China.

BACKGROUND: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). However, the association between CKD and CVD risk in patients with type 2 diabetes mellitus (T2DM) in China has not yet been well investigated. This study aimed to determine the association of CKD with the risks of coronary heart disease (CHD) and stroke in a Chinese population with T2DM. METHODS: A total of 1401 inpatients with T2DM at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2008 and November 2013 were included in this study. The CKD-Epidemiology Collaboration equation for Asians was used to classify CKD. The UK Prospective Diabetes Study risk engine was used to estimate the risks of CHD and stroke. RESULTS: CHD risk was significantly increased with CKD stage (20.1%, 24.8%, and 34.3% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P < 0.001 for all). The stroke risk was also increased with CKD stage (8.6%, 12.7%, and 25.4% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P < 0.001 for all). Compared with no-CKD group, the odds ratios (OR s) for high CHD risk were 1.7 (P < 0.001) in the CKD Stage 1-2 group and 3.5 (P < 0.001) in the CKD Stage 3-5 group. The corresponding OR s for high stroke risk were 1.9 (P < 0.001) and 8.2 (P < 0.001), respectively. CONCLUSION: In patients with T2DM, advanced CKD stage was associated with the increased risks of CHD and stroke.

Pseudohypoparathyroidism with Hashimoto's thyroiditis and Turner syndrome: a case report.

OBJECTIVE: To report the case of an individual with PHP, Turner syndrome and Hashimoto's thyroiditis. CASE: A 16-year-old girl was referred to our hospital with chief complaint of short stature. She presented with round chubby facies, short neck, obesity and short stature. Radiography indicated short metatarsals and metacarpals, which mainly affected the second, third and fourth digits. Biochemistry revealed hyperphosphatemia, increased serum concentrations of parathyroid hormone and thyroid stimulating hormone, elevated levels of follicular-stimulating hormone and prolactin, and increased thyroid peroxidase antibody and thyroglobulin antibody. Radiographic examination revealed delayed bone age and pelvic ultrasonography demonstrated an immature uterus. Karyotype analysis showed 46,X,i(Xq10), while molecular analysis revealed a same sense mutation in exon 5 of GNAS (ATC → ATT, Ile).The specific diagnosis was made of Turner syndrome in the presence of Hashimoto's thyroiditis and PHP. She was treated with calcium supplementation, calcitriol and thyroxine. CONCLUSIONS: This is the first case report to describe a combination of Turner syndrome with these other clinical entities, and their co-existence should be considered and further investigated.

Recurrent ACTH-independent Cushing's syndrome in multiple pregnancies.

A 27-year-old woman presented with Cushing's syndrome. Typical clinical symptoms and signs developed at the beginning of each pregnancy. The latest three pregnancies all ended with natural abortion at about three months. It was the fourth time that she was pregnant. By week 18 of gestation, plasma cortisol diurnal rhythm was absent, basal urinary free cortisol was 1650 µg/24 h and ACTH levels were suppressed. The diagnosis of ACTH-independent Cushing's syndrome was established. Cushing's syndrome in the patient resolved within four weeks of abortion. But signs and symptoms of hypercortisolism recurred in the fifth pregnancy and resolved soon after abortion during the follow-up. The mechanisms by which pregnancy-induced Cushing's syndrome occurred in this patient are unclear. Aberrant responsiveness or hyperresponsiveness of adrenocortical cells to a non-ACTH and non-CRH substance produced in excess in pregnancy should be considered.

[Continuous glucose monitoring in type 2 diabetes with gastroparesis].

OBJECTIVE: To observe the glucose profile in type 2 diabetic gastroparesis. METHODS: 31 patients diagnosed with type 2 diabetes were enrolled into this study for measurement of gastric emptying of solids and continuous glucose monitoring to observe blood glucose levels for 72 hours on a balanced diet; the results were compared with 7 subjects with normal glucose regulation. RESULTS: 58.1% of 31 type 2 diabetic patients were found to have delayed gastric emptying of solids. The average glucose level was lower after breakfast [(7.82 +/- 1.42) mmol/L vs (9.35 +/- 2.28) mmol/L, P < 0.01] in the patients with gastroparesis than in those without. Maximal blood glucose level after breakfast [(10.21 +/- 2.17) mmol/L vs (12.24 +/- 2.82) mmol/L, P < 0.01] was lower in the patients with gastroparesis but it reached the peak at a similar time. Two hour AUC was also lower after breakfast in the patients with gastroparesis [(877.62 +/- 272.78) min x mmol x L(-1) vs (1028.40 +/- 283.98) min x mmol x L(-1), P < 0.05]. CONCLUSION: Post-prandial glucose level in type 2 diabetic patients with gastroparesis tends to be lower than those without.

[Effects of berberine on adiponectin mRNA expression in 3T3-L1 adipocyte].

OBJECTIVE: To explore the effects of berberine and insulin on adiponectin mRNA expression in 3T3-L1 adipocyte. METHOD: The 3T3-L1 adipocyte was treated with berberine and insulin for 48 hours, the level of adiponectin mRNA in 3T3-L1 adipocyte expression was determined with semiquantity RT-PCR using beta-actin as internal reference. RESULT: The level of adiponetin mRNA in 3T3-L1 adipocyte was increased after treated with berberine only (P < 0.05), the effect of berberine was inhibited by high concentration insulin (P < 0.05). CONCLUSION: In vitro, berberine increases the expression of adiponectin in 3T3-L1 adipocyte, insulin inhibits the effect of berberine.