Diabetes is characterized by glycemic disorders which play a key role in the risk for complications of diabetes.Glucose variability is an important parameter of glycometabolism.The study of none evidence-based medicine(EBM) has investigated the relationship among glycemic variability and vascular injury and the subsequent development of diabetes complications.Due to deficiency of large clinical interventional tests,this relationship lack the evidence of EBM.In conclusion,particular attention should be paid to glucose variability in our clinical work and meanwhile the EBM studies should also be conducted.

For different individuals with diabetes,blood glucose control varies.In the blood glucose controlling,blood glucose levels are sometimes higher than the target,sometimes the diabetic patients may develop hypoglycemia.In insulin therapy for blood glucose fluctuations,the most important thing is to avoid hypoglycemia.Finding out regular patterns of blood glucose fluctuations,then according to that,we need to choose the right insulin preparations to treat the condition.For the patients with irregular fluctuations of blood glucose,insulin pump therapy should be a proper choice.

In the past 2013,American Diabetes Association (ADA),American Association of Clinical Endocrinologists(AACE),Chinese Society of Endocrinology,etc.published some guidelines and consensuses on topics such as clinical diagnnsis,treatment,integrated management,and the relationship between reducing body weight and complications.Characters of blood pressure control in diabetic patients were also announced by the Eighth Joint National Committee (JNC 8).Meanwhile,Food and Drug Administration (FDA) declared the statements on safety of several hypoglycemic agents.These guidelines and consensuses will play key roles in standardizing clinical diagnosis,treatment,and medication.

[Summary] Thyroid nodules are the most common endocrine and metabolic diseases,and most of them are accidental nodules.How to distinguish the state between benign and malignant thyroid nodules is the clinical core problems in diagnosis and treatment.In addition to detailed history collecting and physical examination,highresolution ultrasound,serum thyrotrophin levels,and fine needle aspiration biopsy (FNAB) form the basis for the diagnosis of thyroid nodules.Endocrinologists should grasp the indications of FNAB.When the pathological finding is unable to distinguish between benign and malignant nodules,molecular or genetic diagnosis should be adopted for further diagnosis.Appropriate treatment is selected according to the definitive results.In this article,we share the whole process that one case with thyroid nodule was diagnosed as papillary thyroid carcinoma and eventually treated with surgery,so as to make clinicians pay more attention to thyroid nodules with standardized clinical diagnosis and treatment.

ObjectiveTo elucidate the association between RANKL rs7984870 C ＞G polymorphism and the susceptibility to rheumatoid arthritis in a Chinese Han population.MethodsGenotypes were determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) method in 214 rheumatoid arthritis cases and 478 controls.ResultsThe RANKL rs7984870 C＞G genotype frequencies were 27.3% ( CC),51.2% ( CG),21.5% (GG) in the rheumatoid arthritis group and 25.3% (CC),49.1% (CG),25.7% (GG) in the control group respectively; Logistic regression analyses revealed that the risk associated with RANKL rs7984870 C＞G variant genotype was 0.78 (95% CI =0.49-1.24) for RANKL rs7984870 GG compared with its wild-type homozygote.ConclusionRANKL rs7984870 polymorphism may not serve as a risk factor of rheumatoid arthritis susceptibility.Further functional studies are warranted to verify our findings.

[Objective]To explore the clinic results of the locking compression plate fixation for the acetabular fractures.[Method]Twenty-three patients were treated in the author's department, 16 of them were male and 7 were female patients.The ages ranged from 21 to 61 years, and mean age was 43.3 years.Ninteen patients had been injured in an automobile accident,3 were fell from height and 1 was crushed by a heavy object. The patients were classified according to Letournel classification.There were 7 anterior column fractures,3 posterior wall fractures,5 anterior wall fractures,2 transverse fractures,1 anterior column and posterior column fracture,1 T shape fracture, 3 posterior wall and posterior column fractures,1 transverse and posterior wall fracture.[Result]All the incisions healed during the primary procedure and all the patients were available at follow-up ranging from 3 to 24 months(average 20.1 months).The average intraoperation time was 123 minutes(50～235 minutes),and the intraoperative blood loss was 100 to 1500 ml.The patinents underwent blood transfusion from 0 ml to 1 200 ml.According to Matt's criteria, the rate of excellent and good was 73.9%(17/23).[Conclusion]The locking compression plate fixation is one of the effective methods for treatment of acetabular fractures, with the advantages of being simple and minimally traumatic.

In 2015, American College of Endocrinology ( ACE), American Association of Clinical Endocrinologists ( AACE ) , European Association for the Study of Diabetes ( EASD ) , Chinese Society of Endocrinology, American Diabetes Association ( ADA ) , American Association of Diabetes Educators ( AADE ) , Academy of Nutrition and Dietetics(AND), etc. published several guidelines and statements on diabetes and its complications. The selection of hypoglycemic drugs, diabetes self-management education and support, the characteristics of blood pressure and blood lipid, the efficacy and adverse reaction of hypoglycemic drugs were also suggested and recommended. These guidelines and statements will play key roles in the clinical diagnosis and treatment of diabetes mellitus, which is reviewed in this article.

BACKGROUND: Centrifugal force is a contributing factor inducing osteoblastic differentiation from bone marrow stroma cells.OBJECTIVE: To explore whether centrifugal force promote osteoblastic differentiation from rabbit marrow stroma cell seeded on polylactic-co-glycolic acid (PLGA) scaffolds. METHODS: Rabbit bone marrow stroma cells were isolated and cultured by whole bone marrow method, purified by attachment method, and digested by trypsin-EDTA at 80% confluency. The cell concentration was adjusted to 1×10~9/L. PLGA was cut into pieces, 5 mm×5 mm, soaked in serum-conditioned culture medium for 24 hours. The third passage of bone stroma cell suspension at a density of 300 μL was respectively seeded into the PLGA material. The scaffold/cell compound was placed in centrifuge tube, with cell at the upper layer and cultured in osteoblastic induced medium containing antiscorbic acid, β-sodium glycerophosphate, and dexamethasone respectively under centrifugal force every 12 hours (1 000 r/min for 30 minutes, relative centrifugal force 132 g) and static condition. Alkaline phosphatase activity, osteocalcin content and calcium content as well as observation by light microscopy were used to evaluate osteoblastic differentiation. RESULTS AND CONCLUSION: After 16 days of in vitro culture, the scaffolds of centrifugal force group were coated by multiplayer cells and mineralized matrix, but only a thin layer of cells were observed on the scaffold of control group. The centrifugal force system resulted in a significant decrease in alkaline phosphatase activity at day 2 (P < 0.05) but significant increase at day 4 compared with the static culture condition (P < 0.05). During the whole culture time, osteocalcin secretion remained low in control group. At days 12 and 16, a significant enhancement in osteocalcin secretion was observed for centrifugal force culture compared with static culture conditions (P < 0.05). Moreover, after 16 days of culture a significant increase in calcium deposition was observed in the scaffolds subjected to centrifugal force compared with static culture condition (P < 0.05). Centrifugal force can enhance osteoblastic differentiation and mineralized matrix production of bone marrow stroma cell seeded in PLGA.

Objective To compare the clinic effect of the locking compression plate (LCP) fixation and the anatomical plate in treatment of high-energy distal tibial fractures. Methods The study involved 42 patients with high-energy distal tibial fractures treated between May 2003 and May 2009. The anatomical plate group included 24 patients ( 16 males and 8 females, at average age of 39 years), of whom there were 13 patients with type A fractures, five with type B and six with type C according to the AO/ASIF classification. The LCP group included 18 patients ( 15 males and 3 females, at average age of 40 years), of whom there were 11 patients with type A fractures, three with type B and four with type C according to the AO/ASIF classification. All the patients were followed up for 8-17 months. Their functional and radiographic outcomes were collected. The operation time, intra-operative blood loss, X-ray exposure, bone healing time, post-operative complications and therapeutic effects were compared between both groups. Mazur's criteria was used to evaluate the function of the ankle. Results The LCP group was followed up for average 11.6 months and the anatomical plate group for average 14.2 months, which showed fracture healing in all the patients. The bone graft in the anatomical plate group was used more frequently than the LCP group, while the X-ray exposure in the LCP group was much more than that in the anatomical plate group. The operation time, incision size, blood loss, postoperative complications and radiographic bone healing time in the LCP group were significantly less than those in the anatomical plate group. Conclusions Both the LCP and anatomical plate are effective methods for the high energy distal tibial fractures. LCP has advantages of less trauma, quick fracture healing and less complications, is consistent with the biomechanics of internal fixation and hence is an ideal method for the treatment of the high-energy tibial fractures.

Objective To investigate the alteration of energy metabolism and oxidative injury in the myocardia suffering from lethal ventricular tachyarrhythmia (LVTA). Methods Two LVTA-SCD SD rat models, induced by aconitine injection or coronary artery ligation (CAL), respectively, were developed. Rats that died from over-anaesthesia or CAL-induced heart failure were served as their controls, respectively. Mitochondrial membrane potential (MMP), reactive oxygen species (ROS), malonaldehyde (MDA), phosphocreatine (PCr) in the ventricular myocardia, and serum troponin I (cTnI) were detected, and compared between LVTA rats and their controls. Results Fourteen ACO-LVTA and six CAL-LVTA rats were successfully developed. As compared to their controls, ACO-LVTA and CAL-LVTA rats had higher ROS and MDA content, and lower concentration of PCr in the ventricular myocardia. MDA content in ACO-LVTA group is signiifcantly higher than that of its control (P<0.05). MMP in myocardia of ACO-LVTA is lower than that of its control, but is higher than those of two CAL groups. Serum cTnI in rats of both LVTA models is higher than those of their controls and pre-treated control. Specially, serum cTnI in CAL-LVTA was signiifcantly higher than that of ACO-LVTA and its control (P<0.01). The myocardial ROS content is correlated with the duration of VT and VF (P<0.05), with correlation coefifcients being 0.44 and 0.46, respectively. Conclusions After LVTA, the ventricular myocardia had lower MMP and PCr content, higher concentration of ROS, MDA, as well as higher serum cTnI than their controls, indicative of oxidative injury and alteration of energy metabolism under LVTA-SCD.