Objective To investigate the association of the polymorphism of endothelial nitric oxide synthase (eNOS) gene 27bp variable number of tandem repeats (VNTR) with essential hypertension (EH) and type 2 diabetes mellitus (DM) in Chinese population. Methods (1) Genotypes were determined by polymerase chain reaction (PCR)-agarose gel electrophoresis. (2) Fasting serum nitric oxide metabolites (NOx) were measured by nitrate reductase. (3) During oral glucose tolerance test (OGTT) serum immunoreactive insulin (IRI) and C peptide (CP) were measured by radioimmunoassay. Results (1) The frequenciesofaalleleinEHandtype2DMgroupwere significantly higher than that in control group (0.109 vs 0.051; 0.129vs 0.051, P

Objective To observe the effect of diliazem on cerebral oxygen metabolism during the period of blood pressure lowering in hypertensive urgencies.Methods 30 patients of hypertensive urgencies were randomized into two groups with 15 cases each.Group Ⅰ was administered with nitroglycerin.Group Ⅱ was administered with diliazem.Nitroglycerin was injected from 2.5?g/(kg?min).Group Ⅱ were received intravenous injection of diltiazem 5~10 mg,and then were continuously infusion by 5~15?g/kg/min with mictosyringe.Blood gas analysis was carried out by taking blood samples from right internal jugular vein bulb and radial artery,and D(a-jv)O2 and CEO2 were calculated before,during and after induced blood pressure lowering 0.5,1,2,3 hours.Results Compared with those in group Ⅰ,SjvO2 increased significantly in group Ⅱ(P0.05).Conclusion Diltiazem can decrease cerebral metabolism,improve oxygenation and play a role in cerebral protection in hypertensive urgencies.

17α-hydroxylase/17,20-lyase deficiency (17OHD) is a rare cause of congenital adrenal hyperplasia.The patient predominantly presents with low-renin hypertension,hypokalemia,lack of secondary sexual development,and in women with primary amenorrhea,in male with pseudohermaphroditism.We herewith analyse the clinical features of a case of 17OHD diagnosed by gene sequencing.And the etiology,clinical manifestations,genetic features,diagnosis and treatment for 17OHD were reviewed.

Fulminant type 1 diabetes (FT1 D) has been identified as a new subtype of idiopathic diabetes.FT1D is characterized by abrupt and complete destruction of pancreatic β cells,with diabetic ketosis or diabetic ketoacidosis occurring within a week after the onset of hyperglycemic symptoms.At the time of initial presentation,plasma glucose level is increased,with near normal HbA1C.Serum pancreatic enzyme is elevated in the majority of patients with FT1D.Flu-like symptoms or gastrointestinal symptoms precede disease onset in most of patients.However,the pathogenesis of this disease remains unclear.Factors such as viral infection,autoimmune,and pregnancy based on the background of genes may account for FT1D.We herewith report two cases of FT1 D,and review its clinical features,diagnosis,and treatment.

Objective To study the distribution of glycosylated hemoglobin A1c (HbA1c) levels in Xiamen,and to investigate the relationship among HbA1c level and gender and age.Methods This was a cross-sectional study.10 487 cases of physical examination individuals in Zhongshan hospital from January 2013 to April 2014 were recruited.HbA1c was measured by ARKRAY HA-8180 automatic glycosylated hemoglobin analyzer (Japan).All data were collected for analyzing the HbA1c levels in different sex and age groups,exploring the rule between HbA1c and age,and comparing the different diagnostic criteria of diabetes mellitus(DM).Differences between the two groups were compared using the Independent Samples T Test.The measurement data of multiple group were compared with single factor analysis of variance (One way ANOVA),and the comparison between two groups was performed with LSD T test.Correlation between different variables was analyzed by Pearson correlation and linear regression.Results Focused on all the 10 487 cases and 9 436 cases with HbA1c ＜ 6.5％ physical examination population,the levels of HbA1c were positively correlated with age,the linear regression equations were HbA1c (％) =0.021 2 × age (years) + 4.811 9 (r =0.348 9,P=0.000) and HbA1c(％) =0.010 9 × age (years) + 5.0944 (r=0.4257,P =0.000)respectively; HbA1c levels in male physical examination population were significantly higher than those in females (P ＜ 0.001),moreover,in different gender groups,HbA1c level had gradually risen with increasing age.Patients at risk for diabetes (prediabetes,39.60％) diagnosed by the criteria of 2010 American Diabetes Association (ADA) were 2.55 times more than those diagnosed by the criteria of international expert committee (15.55％).Conclusions The HbA1c level is related to age and gender in Xiamen city.It is necessary to establish different reference intervals and DM diagnostic cut-off point.The criteria of 2010 ADA can identify more high-risk DM individuals,with is especially suitable for the physical examination screening.

Factor Xa is a trypsin-like serine protease playing a pivotal role in the blood coagulation cascade.Factor Xa and its inhibitors are of great importance in the development of orally active antithrombotic agents and have aroused considerable attention from the pharmaceutical industry sector over the years.In this review,the structural characteristics of the factor Xa binding site are discussed and the X-ray information available together with the published structure-activity relationship data is used to identify the molecular interactions that are most important for tight enzyme-inhibitor binding,which would be useful in the structure-based drug design of novel factor Xa inhibitors.

Transient receptor potential vanilloid 1(TRPV1)is a nonselective cationic channel,and can be activt-ed by capsaicin,protons and heat.TRPV1 plays a critical role in the initiation of neural inflammatory response and the pathway of pain signal transduction.As a new analgesics,TRPV1 antagonists block pain behaviors in models of inflammatory,neuropathic,and cancer pain.A number of pharmaceutical companies developed a range of TRPV1 antagonists with various structures.It was found that various chemotypes of TRPV1 antagonists would cause an increase in body temperature(hyperthermia),which may become concerns for their development.This article summarizes the recent progress in TRPV1 antagonists development and the relevant hyperthermia.

Type B insulin resistance (TBIR) is a rare disease caused by the presence of insulin receptor autoantibodies (IRA).African middle-aged women are predisposed to it.Most patients have an underlying autoimmune disease,most commonly systemic lupus erythematosus (SLE).The patients predominantly present with abnormalities of glucose homeostasis ranging from extreme insulin resistance and symptomatic hyperglycemia to lifethreatening hypoglycemia,usually accompanied with manifestation of insulin resistance such as acanthosis nigricans,hyperandrogenism,and polycystic ovary.The diagnosis can be established by the elevation of IRA.We herewith report a ease of TBIR complicated with SLE,and the clinical features,diagnosis and treatment of TBIR are reviewed.

Mild cognitive impairment (MCI) is an important risk factor for Alzheimer's disease.It is of great value to investigate the etiology and pathogenesis of MCI.Studies have shown that diabetes may cause damage to both the structure and function of brain tissue,resulting in MCI.We published one article in Diabetes Care titled Serum level of endogenous secretory receptor for advanced glycation end products and other factors in type 2 diabetes patients with mild cognitive impairment to elaborate the relationship between diabetes and MCI.

Objective:To explore the validity of the effective arterial elastance (Ea) before and after fluid challenge in evaluating the fluid challenge in septic shock patients.Methods:A retrospective study was conducted in the medical intensive care unit (MICU) of Peking Union Medical College Hospital from October 2016 to October 2020. 116 septic shock patients were enrolled. All patients received fluid challenge by 500 mL Gelatin or normal saline under invasive hemodynamic monitoring. Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO) and other hemodynamic variables were collected at 10 minutes before and immediately after fluid challenge. An increase in CO greater than 10% after fluid challenge was defined as the positive preload responsiveness, as well as the definition of positive pressure responsiveness was an increase in MAP greater than 10%. Receiver operating characteristic curves (ROC curves) were established to evaluate the predictive abilities of baseline Ea and other arterial load indices in detecting the preload responders and pressure responders. The correlation of the baseline Ea with CO changes after fluid challenge as well as MAP changes were tested by Pearson correlation analysis. Patients with positive preload responsiveness were divided into two groups according to the pressure responsiveness. The changes in Ea and other arterial load indices were analyzed.Results:A total of 116 patients were finally analyzed. Sixty-three patients were preload responders and 53 patients were preload non-responders. There was no significant difference in demographics and baseline physical variables between the two groups. Ea in preload responders was higher than that in preload non-responders (mmHg/mL: 2.51±1.08 vs. 1.87±0.68, P < 0.01). ROC curve analysis showed that the baseline Ea could predict the preload responsiveness at an area under ROC curve (AUC) = 0.71 [95% confidence interval (95% CI) was 0.62-0.81, P < 0.001]. The cut-off value was 1.97 mmHg/mL with a sensitivity of 71.4% and a specificity of 60.4%. The baseline Ea did not present the predictive ability to detect the pressure responders and pressure non-responders (AUC = 0.52, 95% CI was 0.41-0.63, P = 0.73). Pearson correlation analysis showed that the changes in CO after fluid challenge was moderately correlated to the baseline Ea ( r = 0.47, P < 0.001), meanwhile a weak positive correlation between the changes in MAP and baseline Ea was found ( r = 0.20, P = 0.03). In preload responders, 27 (42.9%) of 63 patients were pressure responders and 36 (57.1%) patients were pressure non-responders. No statistical difference was found in the baseline Ea or other arterial load indices between the two groups. Fluid challenge decreased Ea both in pressure non-responders and pressure responders (mmHg/mL: 2.13±0.94 vs. 2.51±1.08, P < 0.01; 2.47±1.18 vs. 2.69±1.30, P < 0.05). Moreover, the changes in CO and changes in MAP were strongly correlated with the changes in Ea ( r values were -0.50 and 0.58, respectively, both P < 0.001). Conclusions:The Ea > 1.97 mmHg/mL before fluid challenge could predict fluid responsiveness in septic shock patients. The baseline Ea was not able to predict the subsequent changes in arterial pressure through fluid challenge. A significant decrease in Ea inducing by fluid administration explained why patients increased their CO without improving blood pressure.