Objective To investigate the relationship between thyroid function indexes and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) among patients who had high risks for cardiovascular diseases without thyroid diseases and heart failure.Methods Totally 166 elderly type 2 diabetic patients aged 80 years and over with normal range of thyroid stimulating hormone (TSH) were divided into group of euthyroid sick syndrome (ESS,n=62) and group of normal thyroid hormones (NESS,n=104).The patients in normal thyroid hormones group were divided into three subgroups according to the levels of total triiodothyronine (TT3),(low-level group,n=26; middle-level group,n=50; high-level group,n=28).Levels of thyroid hormones,NT-proBNP,cholesterol,low-density lipoprotein cholesterol,fibrinogen,HbA1C,glomerular filtration rate (eGRF),left ventricular ejection fraction (LVEF) and the incidences of concomitant diseases were measured and detected.lgNT-proBNP was used to calculated after NT-proBNP was changed by Log transformation.Results Compared with NESS group,ESS group showed that age was increased,systolic pressure and LVEF were decreased [(86.3 ± 5.8) years vs.(85.6 ± 5.2) years,(126.6±15.5) mmHg vs.(135.6±17.8) mmHg,(63.9±7.6)％ vs.(67.4±7.5)％,all P＜0.01].Compared with NESS group,ESS group showed that the levels of serum total T3 and free T3 were decreased [(0.89±0.17) nmol/L vs.(1.45±0.31) nmol/L,(3.31±0.55) pmol/L vs.(3.96± 0.59) pmol/L,both P＜0.01].The lgNT-proBNP level was higher and serum total thyroxine (TT4) level was lower in ESS group than in NESS group [(2.40±0.40) ng/L vs.(2.26±0.44) ng/L,(101.80±36.11) nmol/L vs.(111.07±23.29) nmol/L,both P＜0.05].Pearson analysis revealed that serum levels of TT3,TT4 and FT3 were negatively correlated with lgNT-proBNP (r=-0.217,-0.180,-0.174,respectively,all P＜0.05) after adjustment for age,systolic pressure and LVEF.Stepwise regressive analysis showed TT3 was the risk factors for lgNT-proBNP (β=-0.267,P＜ 0.01).Compared with the low-level group,the lgNT-proBNP were significantly reduced in the middle-,and high-level groups [(2.19±0.42) ng/L,(2.19±0.46) ng/L vs.(2.44±0.39) ng/L,both P＜0.05].Conclusions TT3 has a close correlation with NT-proBNP in elderly type 2 diabetic patients with normal TSH.It has a significant meaning to test TT3 level for monitoring heart function in clinical medicine.

Objective To investigate the association of osteoporosis and coronary artery calcification in elderly patients with type 2 diabetes mellitus (T2DM).Methods A total of 82 elderly T2DM patients underwent dual-energy x-ray absorptiometry scanning (DXA) of lumbar spine and femur neck for getting bone mineral density (BMD),and dual-source computed tomography (DSCT) of coronary artery for calculating calcification score and total calcification score (TCS).All subjects were divided into two groups:osteoporosis group and non-osteoporosis group.The levels of serum calcium (Ca),parathyrin (PTH),phosphorus (P),alkaline phosphatase (AKP),triglyceride (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),low density lipoproteincholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) were detected.Results Compared with non-osteoporosis group,the levels of serum Ca,PTH and TCS were higher [(2.32± 0.15)mmol/L vs.(2.04±0.20) mmol/L;(5.64±1.97) pmol/L vs.(5.01±1.93) pmol/L;(374.4±433.5) scores vs.(242.5±224.8) scores,t=5.790,5.331 and 2.248,all P<0.05] in osteoporosis group.Correlation analysis showed TCS was negatively associated with BMD of L2-4 and femur neck,while was positively associated with serum Ca and PTH (r=0.310,0.246,0.290,0.284 and 0.324,0.575 all P<0.05).Conclusions Osteoporosis is associated with coronary atherosclerosis.TCS could be considered as an index for judging the relationship between osteoporosis and coronary atherosclerosis.

Objective To evaluate plasma natriuretic peptide brain (BNP) levels in elderly male patients with type 2 diabetes and primary osteoporosis.Methods A total of 122 elderly male patients with type 2 diabetes were divided into 3 groups according to bone mineral density(BMD):normal group (41 cases),osteopenia group (40 cases) and osteoporosis group (41 cases),and another 33 age matched healthy subjects as control group.Plasma BNP levels were determined by ELISA.Results Plasma BNP levels in osteoporosis group [(1.95 ± 0.49) pmol/L] and osteopenia group [(1.64±0.48) pmol/L] were significantly elevated compared with that in normal group [(1.32±0.38) pmol/L] and control group [(1.26±0.39) pmol/L] (all P＜0.01).There was a statistical difference between osteoporosis group and osteopenia group (t=3.539,P＜0.05),and also between normal group and control group (t=2.726,P＜0.05).Plasma BNP levels had negative correlation with BMD of 2na-4th lumbar vertebra (r=-0.366) and femoral neck (r=-0.375),body mass index (r=-0.288) and estrodiol (E2) (r=-0.352) (all P＜0.05); while had a positive correlation with parathyroid hormone (PTH) (r=0.353,P＜0.05).Conclusions With BMD declining,plasma BNP levels are elevated in elderly male type 2 diabetes,which may be related to the compensatory increase in PTH and the decrease in estradiol.

Objective To evaluate the effectiveness of treating glioma in combination with drugs multiply by comparing the size of tumor and the survival time of different groups in rat glioma after targeted blood-brain barrier (BBB ) disruption by MRI-guided focused ultrasound.Methods The stereotaxis instruments and the 10 μl gas-tight syringes were used to inject gliosarcoma cells into the targeted area of the brain in 50 male Sprague-Dawley rats.The glioma-bearing rat model was established.Each rat received either:(1 )no treatment (control;n =8);(2)single liposomal doxorubicin (DOX;n = 10);(3)multiple DOX (n =10);(4)single Avastin (AVS)and DOX (n =10);(5)multiple AVS and DOX (n =10).The SonoVue microbubble ultrasonic contrast agent and DOX or AVS were injected into the tail vein respectively on day 12 after implantation.The tumor size was measured by MRI on pre-treatment,immediacy and once a week of post-treatment after targeted BBB disruption by focused ultrasound,and the life span in rat glioma was recorded.Results The mediam survival of different groups in rat glioma(The range of the life span 13-90 d):no treatment (7 d);single DOX (12 d);multiple DOX (1 5 d);single AVS + DOX (22 d), multiple AVS+ DOX (30 d).There was significant difference of the groups on mediam survival comparison (P < 0.01 ).The tumor growth pattern after post-treatment of different groups in rat glioma except control:single DOX was noticeable fast and multiple AVS+DOX was visibly delayed comparable to other groups,and finally the tumor size of multiple AVS + DOX even became small.Conclusions The microbubble blasting enhances the local tissue permeability and promotes the drug delivery of chemotherapy and anti-angiogenesis locally in glioma-bearing rats by MRI-guided focused ultrasound.Especially,the combination with drugs multiply has a synergism efficacy that may enhance the effectiveness of chemotherapy,reduce tumor growth,and even become small of the tumor size,and increase survival time significantly after BBB disruption.

Objective To evaluate the predictive value of fracture risk assessment tool (FRAX) for determining fracture probabilities in middle-aged and elderly patients with type 2 diabetes.Methods Retrospective analysis was carried out on 153 type 2 diabetic patients aged over 50 years undergoing dual energy X-ray absorptiometry measurements.Fracture risk factors including age,gender,height,weight,body mass index,history of previous fragility fractures,parental history of hip fracture,history of smoking,excessive drinking,long-term use of steroid hormone,history of rheumatoid arthritis,the history of secondary osteoporosis diseases,and femoral neck T-score of bone mineral density (BMD) were recorded.FRAX scores with BMD (FRAX/BMD) and without BMD (FRAX/-) were calculated.Therapeutic interventions were recommended if the 10-year risk of fractures was more than 3％ for hip osteoporotic fractures and more than 20％ for other major fractures.Subjects were separated into the identical treatment recommendation group and the different treatment recommendation.Fracture risk factors were compared between groups.Results 133 (6.9 ％) patients had identical fracture risk predictions in the FRAX calculation,regardless of whether BMD join in or not.Age,gender and femoral neck T scores had significant differences between the two groups (all P＜0.001),while other risk factors had no statistical differences between the two groups (all P＞0.05).Conclusions In most middle-aged and elderly patients with type 2 diabetes,the FRAX/-provides the same prediction as FRAX/BMD value for predicting fracture risk,which shows that fracture risks can be predicted without bone density examination.The FRAX/-has higher predictive values on fracture for people who are younger,male,and has higher BMD.

Objective To investigate the relationship of plasma fibrinogen (FIB) and non-highdensity lipoprotein cholesterol (non-HDL-C) with diabetic nephropathy in the elderly with type 2 diabetes. Methods Totally 152 patients (aged 60 years and over) with type 2 diabetics were divided into normal albuminuria (UAER＜30 mg/24 h,n=89) and abnormal albuminuria (UAER≥ 30 mg/24 h,n=63) groups,with high FIB (＞4.00 g/L,n=88) and normal FTB (2.00-4.00 g/L,n=64)sub-groups.The body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting plasma glucose (FPG),postprandial blood glucose (2 hPG),glycated hemoglobin (HbAlc),serum triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),FIB and 24-hour urinary albumin excretion rate (UAER) were measured.The non-HDL-C and estimated glomerular filtration rate (eGFR) were calculated. Results Compared with normal albuminuria group,the values of age,hypertension rate,SBP,Scr and FIB in abnormal albuminuria group were increased [(74.6 ± 7.3) years,57 cases (90.5％),(146.8±23.2)mm Hg,(1.010.7)μmol/L,(4.8±1.5)g/Lvs.(71.6±7.2)years,59 cases (66.3％),(137.7±19.2) mm Hg,(0.8±0.3)μmol/L,(4.2±1.3)g/L,t=-2.536,-2.656,- 2.474,-2.857,x2 =11.936,all P＜0.05] while eGFR was significantly decreased [(68.5±31.2)ml · min-1 · 1.73 m-2 vs.(81.4±25.9)ml · min-1 · 1.73m-2,t=2.791,P＜0.05].The number of patients with high FIB was enhanced in abnormal albuminuria group than normal albuminuria group[45 cases (71.4％) vs. 18 cases (28.6％),x2 =8.085,P=0.004]. The proportion of abnormal albuminuria in high FIB group was lower than that in normal FIB group [(62.6±30.5) ml· min-1 · 1.73 m-2 vs.(83.2±28.7) ml· min-1 · 1.73 m 2,t=2.459,P=0.017].The Pearson analysis revealed that UAER was positively correlated with FIB,TG,TC and non-HDL-C (r=0.276,0.268,0.243,0.176,all P＜0.05).Stepwise regressive analysis showed that FIB was an independent risk factors of urinary albumin in the elderly with type 2 diabetes.Conclusions Higher levels of FIB and non-HDL-C are well correlated with diabetic nephropathy in the elderly with type 2 diabetes.

Objective: To examine the association between serum vitamin D level and thyroid function indicators among elderly patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the prevention and treatment of thyroid function abnormality among elderly patients with T2DM. Methods: Inpatients aged 60 years and older and admitted to the department of endocrinology of Zhejiang Hospital were selected as the study subjects. Gender, age, course of disease and other basic information were collected through questionnaire surveys. The serum 25-hydroxyvitamin D[25-(OH) D], thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) were measured. The correlation between serum vitamin D level and thyroid function indicators in elderly patients with T2DM was evaluated by a multiple linear regression model. Results: A total of 402 elderly patients with T2DM were surveyed, including 210 males (52.24%) and 192 females (47.76%), and had a median age of 70.00 (interquartile range, 12.00) years and a median course of disease of 14.00 (interquartile range, 14.00) years. There were 162 patients with insufficiency of vitamin D (40.30%) and 182 patients with deficiency (45.27%). The levels of TSH and glycated hemoglobin in the vitamin D deficiency group were (2.34±1.66) μIU/mL and (8.83±2.14) %, respectively, which were higher than those in the normal group [(1.74±1.10) μIU/mL and (8.11±1.75) %; P<0.05]. The levels of FT3 and FT3/FT4 in the vitamin D deficiency group were (2.86±0.48) μIU/mL and 2.85±0.71, respectively, which were lower than those in the vitamin D insufficiency group [(3.09±0.47) pg/mL and 3.14±0.81, P<0.05]. Multiple linear regression analysis showed a negative correlation between 25- (OH) D and TSH (β'=-0.159, P=0.001). Conclusion The vitamin D deficiency may be associated with the increase of TSH level among the elderly patients with T2DM.

The European Society of Intensive Care Medicine (ESICM) issued the second consensus on the assessment of sublingual microcirculation in critically ill patients. This paper interprets the consensus for clinicians about: what is microcirculation, how to observe microcirculation, and the details of microcirculation images collection and parameters analysis. Besides, this paper illustrates the relationship between microcirculation alternation and shock, it also evaluates the present situation and future development of microcirculation monitoring.

Objective Recombinant human parathyroid hormone(1-34) [ rhPTH(1-34)] is the unique anabolic substance acting on the skeleton. The efficacy and safety of long-term administration of rhPTH(1-34) in Chinese postmenopausal women have not been evaluated. This study compared the clinical efficacy and safety of rhPTH(1-34) with elcatonin for treating postmenopausal women with osteoporosis in 11 urban areas of China. Methods A total of453 postmenopausal women with osteoporosis were enrolled in an 18-month, multi-center, randomized, controlled study. They were randomized to receive either rhPTH(1-34) 20 μg(200 U) daily for 18 months, or elcatonin 20 U weekly for 12 months. Lumbar spine ( L1-4) and femoral neck bone mineral density (BMD), fracture rate, back pain as well as biochemical markers of bone turnover ( serum bone-specific alkaline phosphatase was measured by radioimmunoassay; C-telopeptide/ creatinine ( CTX/ Cr) measured by quantitative sandwich enzyme-linked immunosorbent assay) at 6, 12, and 18 months. Adverse events were recorded. Results rhPTH(1-34) increased lumbar BMD more significantly than that did by elcatonin at 6 months( M6), 12 months (M12), and 18 months(M18; 4. 3% vs 1. 94% , 6. 8% vs 2. 72% , 9. 51% vs 2. 86% , P<0. 01). There was only a small but significant increase of femoral neck BMD at M18(2. 64% , P<0. 01) in rhPTH(1-34) groups. There were greater increases in bone turnover markers in the rhPTH(1-34) group than in the elcatonin group at M6, M12, and M18[serum bone-specific alkaline phosphatase(BSAP) 93. 67% vs -3. 56% , 117. 78% vs -4. 12% , 49. 24% vs-5. 81% , P<0. 01; urinary CTX/ Cr 250% vs -29. 5% , 330% vs -41. 4% , 273 % vs -10. 6% , P<0. 01]. rhPTH (1-34) showed similar effect of pain relief as elcatonin. The incidence of clinical fractures was 5. 36% (6 / 112) in elcatonin group and 3. 23% ( 11 / 341 ) in rhPTH ( 1-34 ) group ( P = 0. 303 ). Both treatments were well tolerated. Hypercaluria(9. 38% ) and hypercalcemia(7. 04% ) in rhPTH(1-34) group was transient and caused no clinical symptoms. Pruritus(8. 21% vs 2. 68, P=0. 044) and redness of injection site(4. 40% vs 0, P=0. 024) were more frequent in rhPTH(1-34). Nausea / vomiting(16. 07% vs 6. 16% , P = 0. 001) and hot flushes(7. 14% vs 0. 59% , P<0. 001) were more common in elcatonin group. Conclusion rhPTH(1-34) treatment was associated with greater increases in lumbar spine BMD and bone formation markers. It could increase femoral BMD after 18 months treatment. rhPTH(1-34) could ameliorate back pain effectively. The results of the present study indicate that rhPTH(1-34) is an effective, and safe agent in treating postmenopausal women with osteoporosis.