Pituitary hyperplasia may be found in patients with primary hypothyroidism as the decreased thyroid hormone level attenuates negative feedback effect.Sometimes the enlarged pituitary may be misdiagnosed as a pituitary tumor.Patients with long term untreated hypothyroidism often have extremely high level of serum creatine kinase and thus may be misdiagnosed as suffering from myositis.In order to increase the awareness of the nonspecific symptoms of primary hypothyroidism,this article introduces the diagnosis and treatment of a patient with primary hypothyroidism with raised serum creatine kinase level and pituitary hyperplasia.

Objective To investigate the feasibility of inducing neonatal immunotolerance against Graves'disease by gene TSH receptor (TSHR) 289 and its possible mechanism.Methods Neonatal (0-24 h) female BALB/c mice were divided into intraperitoneal injection group,intramuscular injection group,model group,and normal control group.The intraperitoneal group and the intramuscular group were further divided into low-dosage,middle-dosage,high-dosage tolerance groups,and the coresponding control groups.The tolerance groups and the controls were intraperitoneally or intramuscularly pretreated with low-dosage( 1×106 particles),middle-dosage( 1 × 108particles),high-dosage( 1 × 1010 particles)of Ad-TSHR 289 or Ad-lacz respectively.6 to 7 weeks later,the normal control group received intramuscular injection with Ad-lacz; the other groups were immunized with Ad-TSHR289,three times at 3 weeks interval.10 days after the first immunization,serum TRAb was detected.4 weeks after the last immunization,serum TRAb,TT4,splenic CD4 + CD25 + Foxp3/CD4 + were tested,and the thyroid tissues were examinated histologically.Results Ten days after the first immunization,no antibody response against TSHR was detected in the two high-dose tolerance groups,but the TRAb titer in respective controls was significantly higher( P＜0.05 ).4 weeks after the last injection,in high-dose tolerance groups,only 1/10 of mice immunized by intraperitoneal or intramuscular injection elicited anti-TSHR antibody,and no mice immunized intraperitoneally had elevated serum TT4.Two of ten mice challenged intramuscularly showed slightly increased TT4 levels,but the respective controls displayed a strong antibody response( P＜0.01 ) and elevated TT4 level ( P＜0.05 ).The similar percentages of high TT4 and thyroid hyperplasia were found in all groups.Additionally,the frequencies of CD4+CD25 +Foxp3/CD4+in two high-dose tolerance groups were significantly increased as compared to those in controls( P＜0.05 ).The incidence of Graves' disease in the other groups by intraperitoneal or intranuscular injections was not statistically different from those in the corresponding control groups and the model group.Conclusions The immune tolerance against Graves'disease is induced in neonatal mice by either intraperitoneal or intramuscular pathway with specific antigen of TSHR 289,carried by adenovirus vector,and then inhibits Graves' disease in adults. Stimulation with the high-dosage antigen is liable to induce immune unresponsiveness.CD4 + CD25 + Foxp3 +T cells may play an important role in the induction and maintenance of tolerance.

The levels of macrophage migration inhibitory factor (MIF) in peripheral blood mononuclear cell (PBMC) and serum in patients with Hashimoto's thyroiditis (HT) were detected by real-time PCR and ELISA,respectively.The results revealed that the expression of MIF mRNA in PBMC ( Z =-4.276,P＜0.01 ) and protein level in serum ( Z=-5.358,P＜0.01 ) were increased in HT patients,and positively correlated with thyroid specific autoantibodies and TSH levels.

Objective To evaluate the satisfaction and usability of SoloStar(R),a prefilled pen for injecting insulin glargine ( Lantus(R),Sanofi ) in Chinese diabetic patients.Methods This was a 3-month,observational,multicenter,prospective registry study in adult diabetic patients who were ever insulin users or insulin naive.The SoloStar(R) was prescribed at physician's discretion.At baseline,patients were asked to evaluate their previous insulin pen if applicable.After 3-month SoloStar(R) use,the satisfaction and usability in using SoloStar(R) were assessed,and the evaluation from physicians was also collected.Results Total 1052 patients aged 56.5 years (27.6％ ≥65years),with mean diabetes duration 7.6 years,54.6％ male,94.1％ type 2 diabetes,6.5％ visual impairment,and 2.4％ dexterity impairment,were analyzed.Of these,488 patients (46.4％) had previously used insulin pen.Most patients (95.3％) rated SoloStar(R) assatisfied/very satisfied.Most patients planned to continue using SoloStar(R)(94.7％) and would recommend it to others(86.0％ ).Compared with previous insulin pen,most patients felt using SoloStar(R) became easier ( 57.3％ ) and more convenient ( 60.7％ ).63 physician questionnaires were analyzed,over 70％ physicians rated SoloStar(R) features as good/excellent,and 96.8％ physicians regarded training on SoloStar(R) as easier and quicker than other pens.Conculsion Most patients were satisfied/very satisfied with SoloStar(R) and most physicians rated SoloStar(R) as good/excellent,suggesting that SoloStar(R) was well accepted by patients and physicians in China.

Objective To explore the relationship between the change in waist circumference (WC) and new onset diabetes (NOD) in a population of north China.Methods A total of 101510 subjects took part in the health examination from 2006 to 2007 for the employees of Kailuan Group.89364 subjects with fasting plasma glucose (FPG) ＜7.0 mmol/L,no history of diabetes,with complete data of FPG and WC,and without taking hypoglycemic agents were sclected as the observation cohort.Subjects who did not participate in the health examination from 2010 to 2011 and had incomplete data were finally excluded and thus 58426 subjects were included for final analysis.According to the baseline WC measurement and its quartile in the health examination during 2006 to 2007,the observed population was divided into two groups (obese group and non-obese group) or four groups ( first,second,third,and forth quartile groups).Multiple logistic regression analysis was used to test the relation between the change in WC and NOD.Results ( 1 ) The incidence of NOD in obese group was higher than that in non-obese group (8.02％ vs 3.37％,P＜0.01 ).Along with increasing WC in the 4 quartile groups,the incidence of NOD was progressively increased,being 2.32％,3.62％,5.46％,and 8.89％ respectively in the total population ( 2.84％,3.65％,5.32％,and 8.95％ in male,and 1.50％,3.41％,6.22％,and 8.51％ in female).( 2 ) Multiple logistic regression analysis showed that compared with the first quartile group,the second,third,and forth quartile groups had increased risks of NOD after adjusting age,gender,and other risk factors,the OR value being 1.17,1.47,and 1.95,respectively.After adjusting above factors in different genders,the influence of the second group on NOD in males and females was not significant,however,they still increased the risks of NOD,with the OR value being 1.08,1.36,and 1.90 in male,and 1.35,1.70,and 1.88 in female,respectively.Conclusion The incidence of NOD is increased with increasing WC.

Sixty-six volunteers,including 24 subjects with normal glucose tolerance(NGT),18 patients with impaired glucose regulation (IGR),and 24 patients with type 2 diabetes mellitus ( T2DM ),underwent a test of continuous glucose monitoring.The data of continuous glucose monitoring were embedded into two-dimension Euclid space by Takens' embedding theory.Glycemic phase diagram was drawn by MATLAB.The area and center distance of glycemic phase diagram were calculated by computer.The distinction of glycemic variability and average glycemic level among different glucose regulation populations were analyzed.The results showed that there existed significant differences in body mass index,systolic blood pressure,diastolic blood pressure,low density lipoprotein-cholesterol,high density lipoprotein-cholesterol,triglyceride,total cholesterol,creatinine,and alanine aminotransferase among three groups( all P＜0.05 ).The levels of HbAIC,fasting plasma glucose( FPG ),postprandial 2 h plasma glucse (2hPG),area and center distance of glycemic phase diagram in T2DM group were higher than those in NGT and IGR groups( P＜0.01 ),and the levels of FPG,2hPG,area and center distance of glycemic phase diagram in IGR group were higher than those in NGT group( P＜0.01 ).The levels of FPG and 2hPG were correlated with area and center distance of glycemic phase diagram ( all P＜0.01 ).These results suggest that measuring the area and center distance of glycemic phase diagram is a good method to assess glycemic variability and average glycemic level during continuous glucose monitoring.

133 male patients with type 2 diabetes mellitus were divided into non-atherogenic phenom( N group ) and atherogenic phenom( A group) according to the c utpoint of atherogenic index of plasma (AIP) at 0.06.The clinical chemistry data were compared between two groups.The results showed that body mass index ( BMI ),waist-tohip ratio (WHR),homeostasis model assessment insulin resistance index ( HOMA-IR ) and insulin secretion index (HOMA-IS),serum triglyceride (TG),very low density lipoprotein-cholesterol (VLDL-C),serum uric acid ( SUA ),urine uric acid ( UUA ),and urine micro-albumin ( UMA ) levels in A group were higher than those in N group ( all P＜0.05 ),while high density lipoprotein-cholesterol ( HDL-C ) level was lower ( P＜0.01 ),as well as higher coronary heart disease incidence in A group as compared with N group( P＜0.05 ).Correlation analysis revealed that AIP was positively related with age,BMI,WHR,HOMA-IR,HOMA-IS,systolic blood pressure,diastolic blood poressure,TG,total cholesterol,VLDL-C,SUA,UUA,and UMA( all P＜0.05 ),and negatively related with HDL-C (P＜0.01).Multivariant stepwise linear regression analysis revealed that TG,HDL-C,V LDL-C,and UUA were independent influential factors for AIP.

Amino acids (AA) as substrates of gluconeogenesis could promote endogenous glucose production.Some AA can enhance insulin secretion. Recently,many studies have found that some AA can also activate mammalian target of rapamycin-S6 kinase 1 ( mTOR-S6K1 ) pathway,resulting in maintaining pancreatic β cell function on one hand,and on the other hand,inhibiting insulin signal transduction of insulin-sensitive cells and thus causing insulin resistance.

After 4 weeks old male Sprague-Dawley rats were fed with normal diet and high-fat diet for 10 weeks,the rats were treated with metformin (200 mg/kg) for 6 weeks. Insulin sensitivity was determined by hyperinsulinemic-euglycemic clamp technique.Realtime PCR and western blot were used to measure mRNA and protein levels of chemerin in perirenal adipose tissue of rats.The results showed that the expressions of chemerin mRNA and protein were higher in high-fat diet-induced insulin resistant rats compared with rats fed with normal diet ( both P＜0.05 ),and these incremental findings were diminished by metformin treatment ( both P＜0.01 ).The levels of chemerin mRNA and protein were correlated well with the epididymis fat mass index.

Eleven old male patients with hyperuricemia were collected ( hyperuricemia group,65-90 years old ).10 healthy middle-aged males ( middle-aged group,30-40 years old) and 10 healthy old males ( older group 60-70 years old ) with normal blood uric acid level were used as controls.All of the subjects were given low purine content diet ( 250 mg/d ) for 3 days followed by high purine content diet ( 800 mg/d ) consecutively for another three days.The samples of fasting blood and 24 h urine were collected for assay.The results showed that there were no significant changes of serum uric acid ( UA ) concentration in three groups after low purine content diet.But the levels of serum UA in three groups all increased significantly after high purine content diet,and the change was higher in hyperuricemia group than middle-aged group [ ( 507.7 ± 108.1 vs 378.9 ± 80.1 ) μmol/L,P＜0.05 ].24 h urine uric acid excretion in three groups was all significantly decreased after low purine content diet and increased after high purine content diet.After high purine content diet,24 h urine uric acid was lower in hyperuricemia group than middle-aged group [ ( 2.99 ± 1.21 vs 3.62 ± 1.02 ) mmol/24 h,P＜0.05 ].Blood urea nitrogen levels in all subjects decreased after low purine content diet and increased after high purine content diet ( P＜0.05 or P＜0.01 ).Creatinine clearance rate in hyperuricemia group was decreased after high purine content diet compared with baseline [ (75.3 ± 20.3 vs 80.7 ±20.0) ml/min ],and there were no significant changes in other groups after low and high purine content diet.24 h urine protein in hyperuricemia group was higher than middle-aged group ( P＜0.05 ),and increased after high purine content diet with significant difference ( P＜0.05 ).These results suggest that high purine content diet and decreased by renal uric acid clearance mainly contribute to hyperuricemia in old people.