In the diagnosis of primary osteoporosis,the secondary osteoporosis should be excluded first because it covers many kinds of diseases.At this point,the differential diagnosis is required and a wide variety of knowledge of internal medicine is prior to all others.Bone mineral density measurement is only one of the references for the diagnosis of primary osteoporosis instead of being the unique criterion.

After double tetracycline labelings, undecalcified bone sections stained with Villanueva bone stain and toludine blue were studied through bone histomorphometry in 3 cases of PHPT associated with osteomalacia. The results showed heterogeneity of mineralization defect at different locations of each section, suggesting that the mineralization process had a dependency on the balance between the stimulating effects of excess PTH on bone formation and osteomalacic tendency due to vitamin D deficiency in PHPT associated with osteomalacia or rickets.

[Summary] Vitamin D is one of the fat-soluble vitamins which,eventually through activation in the liver and kidneys within the human body,becomes an important hormone——1,25-dihydroxyvitamin D3.Not only may 1,25dihydroxyvitamin D3 promote calcium and phosphate absorption by the intestine,but also stimulate the macrophages to secrete a protein(cathelicidin) which is able to digest the microbacterias,including viruses and bacteria,playing an antiinfective effects.Theofore,a proper supplementation of vitamin D would be beneficial for human health.

ObjectiveTo investigate whether the good control of fasting plasma glucose(FPG) has any effects on bone turnover rate in type2 diabetes mellitus (DM).MethodsA series of markers,such as bone specific alkaline phosphatase (BAP),deoxypyridinoline (DPD),were assessed before and after glycemic control for more than 18 days in 43 poorly controlled type 2 DM patients with initial hemoglobin A1c over 8%.ResultsBy either oral hypoglycemic agent or insulin administration,or both, ideal control of FPG resulted in a reduction in the secretion of urinary calcium(Ca),phosphate(Pi) and magnesium(Mg),and an increase in serum Ca and Pi without obvious changes in serum Mg.The marker for bone resorption,urinary DPD and the marker for bone formation,BAP in serum were reduced significantly before and after the management.The results indicated that the decreases both in DPD and in BAP were not only correlated well with each other,but with the improvement in glycemic indices as well.ConclusionGood control of hyperglycemia in poorly controlled type 2 DM may have the high bone turnover rate back to normal and protect type 2 DM patients from bone loss.

BACKGROUND: As a multifunctional cell growth factor, vascular endothelial cell growth factor (VEGF) plays various biological roles under some physiologic and pathologic conditions. OBJECTIVE: To summarize molecular structure and biological effects of VEGF. RETRIEVAL STRATEGY: A computer-based online search of PubMed database was undertaken to identify related English articles dated from January 1989 to December 2007 with keywords"VEGF, molecular structure, biological effect, diabetes, diabetic macroangiopathy". 934 articles were firstly collected, including 38 about molecular structure and biological effects of VEGF, and 896 about diabetes and diabetic macroangiopathy. After the first trial, only articles about ①molecular structure and biological characteristics of VEGF, and ②diabetes and diabetes complicated by coronary heart disease or limb vascular disease were selected. 897 repetitive, outdated and unrelated articles were excluded. Finally, 35 articles were included. LITERATURE EVALUATION: Of 35 articles, there were 17 ones about animal trials, and in vivo, in vitro and cytological studies, 8 of review articles and comments, and 10 clinical studies. All articles were individual evaluation. DATA SYNTHESIS: Human VEGF genes consist of 8 exons and 7 introns, and are located in 6p21.3 region. VEGF encodes several isoforms with different biological characteristics. Two VEGF receptors display different biological effects. VEGF and its receptors are regulated by various factors. The receptors interact with ligand and play biological effect. In diabetic patients complicated by coronary heart disease, myocardial VEGF mRNA and protein expressions are increased but the expressions of two kinds of receptors are decreased compared with non-diabetic patients. Compared to patients with non-severe lower limb ischemia, VEGF production is more in diabetic patients complicated by severe lower limb ischemia. It is demonstrated that VEGF can restore injured neovascularization. However, VEGF therapy for diabetes still needs further study. CONCLUSION: VEGF can restore impaired neovascularization. VEGF expression shows diversity under diabetic macroangiopathy. Further study should be made focusing on the prevention value of VEGF to diabetic macroangiopathy.

ObjectiveTo investigate the kidney protective e ffects of losartan in diabetic rat and its kidney protective mechanism. MethodsThe rats were randomly divided into the following groups:norm al control (group C), streptozotocin diabetic (group DM) and diabetic rats t reated with losartan (group DL). After eight weeks study, the mRNA expressions of transforming growth factor ? 1(TGF ? 1), TGF ?type Ⅱ receptor (T? RⅡ)and fibronectin in renal cortices of all three groups were measured by quan titative reverse transcription and polymerase chain reaction(RT PCR). The prote in expressions of transforming growth factor ? 1(TGF ? 1), T?RⅡ and fib ronectin in renal cortices of all three groups were measured by histoimmunochemi stry.The levels of blood glucose,urea and creatinine were measured by biochemic al assy.The concentrations of blood insulin and angiotensin Ⅱ were measured by radioimmunoassay. The rates of urinary albumin excretion were measured by sulfos alicylic acid assay.ResultsAfter eight weeks, mean glomerula r volume, kidney weight / body weight ratio, urinary albumin excretion ratio, bl ood urea and creatinine were significantly higher in diabetic group than in norm al control group(P

ObjectiveTo investigate feasibility of use of glucose injection instead of glucose powder in oral glucose tolerance test (OGTT). MethodsSixty healthy adult volunteers without history of diabetes were recruited for a standard OGTT with 75 g anhydrous glucose powder first. One week later, they were randomly divided into two groups, each of the one group (30 volunteers) orally took seven ampoules (20 ml/ampoule) and each of the other group (30 volunteer) took 7.5 ampoules of 50％ glucose injection for OGTT again, as compared to those with standard OGTT.Plasma levels of glucose and insulin were examined to evaluate whether different forms and dosage of glucose had similar results in OGTT. ResultsIn 23 volunteers with normal glucose tolerance, their plasma levels of glucose were ( 4. 8 ± 0. 4 ), ( 6. 7 ±0. 6), (5.9 ±0. 8), (5.5 ±0. 9) and (4. 8 ±0. 9) mmol/L at 0, 30, 60, 120 and 180 min after oral load with 75 g anhydrous glucose powder, respectively. These values changed to (4. 8 ± 0. 3 ), (7.5 ± 1.1 ),(6.8±1.8), (6.3 ±1.0) and (4.6 ±1.2) mmol/Lor (4.7 ±0.3), (7.2±1.3), (6.1 ±1.1),(5.6 ± 0. 9 ) and (4. 3 ± 0. 9) mmol/L after oral load with seven ampoules ( 15 volunteers) or 7. 5 ampoules of (8 volunteers ) of 50％ glucose injection, respectively.With standard OGTT, 37 cases of impaired glucose tolerance were found from 60 volunteers tested, and their plasma levels of glucose were (5. 2 ±0.6), (9. 1 ±1.4), (8.9 ±2.6), (6.7±2.0) and (4.7 ±1.0) mmol/L at 0, 30, 60, 120 and 180 min after oral load with 75 g anhydrous glucose powder, respectively; (5. 1 ± 0. 7 ), ( 8. 8 ± 1. 7 ), (9. 0 ±3.0), (7.3±2.2) and (5.1 ±1.1) mmol/L (15 volunteers) or (5.3 ±0.6), (8.8 ±1.9), (8.5 ±2. 4), (6. 6 ± 1.4) and (4. 8 ± 1.6) mmol/L (22 volunteers) at 0, 30, 60, 120 and 180 min after oral load with seven or 7.5 ampoules of 50％ glucose injection, respectively, with no statistically significant difference between varied methods.Normal serum level of insulin was found in 38 of 60 volunteers, with their logarithmic transformation of serum insulin levels of 1.5 ± 0. 3, 3.9 ± 0. 3, 3.7 ± 0. 4, 3.2 ± 0. 6 and 2.2 ±0. 8 at 0, 30, 60, 120 and 180 min, respectively after glucose load in standard OGTT, and 20 of 38 volunteers with normal serum insulin of 1.7 ± 0. 4, 3.9 ± 0.4, 3.4 ± 0. 7, 3.3 ± 0. 8 and 2. 4 ± 0. 7 at 0,30, 60, 120 and 180 min after oral load with seven ampoules of 50％ glucose injection, respectively, or 18 of 38 with normal serum insulin of 1.7 ± 0. 4, 3.9 ± 0. 4, 3.8 ± 0. 5, 3. 3 ± 0. 7 and 2. 3 ± 1.0 at 0, 30,60, 120 and 180 min after oral load with 7. 5 ampoules of 50％ glucose injection, respectively, with no statistically significant difference between varied methods. Twenty-two cases of high serum level of insulin were found from 60 volunteers with standard OGTT, with their logarithmic transformation of serum insulin of 2.2±0.6, 4.7 ±0.5, 4.9±0.7, 4.2 t 1.0 and 2. 8 ±0.9 at0, 30, 60, 120 and 180 min after oral load with 75 g anhydrous glucose powder, respectively; 10 of 22 volunteers were found with high serum insulin level of its logarithmic transformation of 2. 4 ± 0. 6, 4. 7 ± 0. 5, 4. 7 ± 0. 3, 4. 1 ± 0. 8 and 2. 8 ± 1.1 at 0,30, 60, 120 and 180 min after oral load with seven ampoules of 50％ glucose injection, respectively ; and 12 of 22 volunteers were found with high serum insulin level of its logarithmic transformation of 1.9 ± 0. 5,4. 5 ± 0. 6, 4. 6 ± 0. 6, 3. 7 ± 1.0 and 2. 4 ± 0. 9 at 0, 30, 60, 120 and 180 min after oral load with 7. 5ampoules of 50％ glucose injection, respectively; with no significant difference between varied methods.There also was no statistically significant difference in occurrence of adverse effects between these three OGTT methods. ConclusionsEither seven or 7. 5 ampoules of 50％ glucose injection can substitute 75 g anhydrous glucose powder in OGTT, with similar test results and safety.

Objective To assess the effects of artificial cordyceps sinensis(Jin shuibao) on the numbers of podocytes and epithelial-mesenchymal transition in diabetic rats.Methods Diabetes was induced by intraperitoneal injection of low dose streptozocin.Sprague-Dawley rats were randomly divided into three groups:control group (CON),diabetic model group(DM),and artificial cordyceps sinensis treatment group(CS).After intervention for 8 weeks,the numbers of podocytes were estimated hy immunohistochemistry.The expressions of nephrin,desmin,and monocyte chemoattractant protein-1 (MCP-1) were detected.Results Compared with control group,DM group showed significantly decreased podocyte numbers and nephrin mRNA,with increased desmin and MCP-1 levels(P＜0.05).While the numbers of podocytes and nephrin mRNA were increased,and the expressions of desmin and MCP-1 were decreased in CS group as compared with those in DM group (all P＜0.05).Conclusions Artificial cordyceps sinensis notably improves epithelial-mesenchymal transition of podocytes,and increases the number of podocytes in diabetic rats.

Objective To investigate the relationship between HLA DRB1 gene polymorphism and susceptibility to leukopenia in patients with Graves′ disease (GD). Methods The HLA DRB1 alleles were typed by the polymerase chain reaction based sequence specific primer (PCR SSP) method in 45 GD patients with leukopenia, 50 GD patients without leukopenia and 90 normal controls. The allele frequencies in the leukopenic GD group were compared with those in the GD patients without leukopenia and control group. Results (1)Gene frequencies of HLA DRB1*08 (P