Visceral obesity is closely related to development of insulin resistance,metabolic syndrome,type 2 diabetes mellitus,and cardiovascular disease.Visceral obesity leads to increased insulin resistance,which is an important risk factor for the development of type 2 diabetes mellitus.Weight loss,especially reduction of visceral adipose,can improve insulin sensitivity effectively,and thereby reduce the risk of obesity-related type 2 diabetes mellitus and cardiovascular disease.Studies have confirmed that liraglutide,as an analogue of human glucagon like peptide-1 (GLP-1),when used early in type 2 diabetes patients with obesity,can not only control glycemia and protect β-cells,but also significantly lose weight,and its benefit on weight is mainly based on the reduction of visceral adipose.Therefore,early application of liragtutide in type 2 diabetes with obesity will provide a new choice for the treatment of type 2 diabetes mellitus.

Dipeptidyl peptidase-Ⅳ (DPP-Ⅳ/CD26,EC 3.4.14.5),a transmembrane serine polypeptidase,is widely distributed and has diverse effects.As a dipeptidase,DPP-Ⅳ/CD26 could not only regulate the activity of many peptide hormones,neuropeptides,cytokines and growth factors via its peptidase function,but also mediate cell-matrix and cell-cell contact through interactions with other molecules or proteins as a surface antigen.DPP-Ⅳ/CD26 plays a regulatory role in immune activation,inflammation and tumorigenesis.This review covers the structure,distribution,physiological functions and changes in pathological state of Dpp-Ⅳ/CD26.

Objective To analyze the hospitalization rates of diabetic patients in different departments in different years and compare the differences in hospitalization costs, length of stay, and mortality between diabetic and non-diabetic patients. Methods The clinical data of hospitalized patients from 1995 to 2009 in different departments of Peking Union Medical College Hospital were retrospectively analyzed. Patients were divided into three groups by calendar period (every five years) and into four groups by ages. Results A total of 500 523 patients were enrolled in this study. From 1995 to 2009, the hospitalization rates of diabetic patients increased from 2.85% to 7.65% , especially among patients who were treated in the departments of cardiology, ophthalmology,and vascular surgery. In 2009, the hospitalization rates of diabetic patients in the three departments were 29.36% , 24. 51% , and 21.25 % , respectively. The length of hospital stay was significantly longer among diabetic patients than among non-diabetic patients (P ＜ 0. 001). The total hospital costs were also significantly higher among diabetic patients than among non-diabetic patients in all the period and age groups (P ＜ 0.01 or P ＜0.001)except in 2000-2004 group and 2005 - 2009 group in 0 - 18 years group (P ＞0. 05). The hospital cost per day in diabetic patients was significantly lower than that in non-diabetic patients in all the period and age groups (P ＜ 0. 05, P ＜ 0. 01 or P ＜ 0. 001)except in 1995-1999 group in over 65 years group (P ＞ 0.05). The mortality rate of diabetic patients in the 1995-2004 in 0-18 years group was zero, and the mortality rates were not significantly different between diabetic patients and non-diabetic patients in 2005 -2009 group in 0-18 years group (P ＞0.05), and were significantly higher in diabetic patients than in non-diabetic patients in all other period and age groups (P ＜0.01 or P ＜ 0. 001). Conclusions Diabetic inpatients tend to have a longer hospital stay, higher hospitalization rate, higher hospital costs, and higher mortality rates. A hospital-wide diabetes management mode should be developed to optimize its treatment.

Objective To understand the application of dietary supplements among adult patients with type 2 diabetes mellitus (T2MD) in two areas of China. Methods A total of 615 T2MD patients were recruited from three hospitals in Beijing and Shenyang, with convenience sampling for the study using self-reported questionnaires. Data were statistically analyzed. Results Overall 34. 8% of the participants (22.5% in Beijing and 45.5% in Shenyang, respectively) reported ever use of at least one dietary supplement in the past 12 months. The most commonly used supplement was royal jelly ( 16. 1% ), followed by vitamins ( 10. 1% ), calcium (8. 8% ),fish oil (7. 3% ), spirulina (3.9%), and lecithin (2. 3% ). Except that royal jelly was used for complementary treatment for T2MD, most of the other supplements were used for improving their body defense. In addition, more than 20 other health dietary supplements were also used for diabetes-related conditions in 8. 5% of the participants surveyed. The participants' main sources of information about dietary supplements were from mass media or recommendations by relatives and friends. About half of supplements users perceived that the dietary supplements were effective. The application of dietary supplements was associated with gender, educational background, living area,perceived burden of medical cost, stage of diabetes, comorbidity, and body mass index (BMI) of the patients ( all P ＜0. 05). Conclusions Dietary supplements are widely used among T2MD patients in Beijing and Shenyang.The types of these dietary supplements are diverse and lack professional instructions. It is recommended that information on dietary supplements should be included in diabetes education.

Objective: To observe the clinical effect of sodium nitroprusside and dopamine injected by micro pump for the treatment of refractory heart failure. Methods:One hundred and six cases of patients with refractory heart failure were chosen as the research object, which were cardiac functionⅢ~Ⅳlevel. All patients were treated with sodium nitroprusside and dopamine injected by micro pump. Starting dose of sodium nitroprusside was 6.25 μg/min. At same time pumping dopamine, starting dose of 2 g/kg·min, the dose was increased gradually until blood pressure dropped to 90~100 mm Hg, continuous 7~10 d, the signs and symptoms after treatment and parameters of cardiac function and adverse reactions were observed. Results: 1)In 106 cases of patients with refractory heart failure after treatment, the total effective rate 85.85%(91/106). 2)The heart rate, blood pressure, cardiothoracic ratio, left ventricular short axis reduced rate,cardiac output, each index of cardiac,indexes of left ventricular ejection fraction were improved significantly after treatment. Conclusion:The clinical effect for the treatment of refractory heart failure by using the micro pump injection of small doses of sodium nitroprusside combined dopamine would be obvious, have less adverse reactions, worthy of clinical popularization and application.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays an important role in lipid reg-ulation through interaction with low-density lipoprotein cholesterol receptors , and several types of PCSK 9 inhibi-tors are gradually becoming research hotspots due to their lipid lowering effect .Among them PCSK9 monoclonal antibodies are the closest to clinical application , and a number of phase Ⅲclinical trials in PCSK9 monoclonal antibodies have been completed in recent years .We systemically reviewed the current clinical research on PC-SK9 monoclonal antibodies in this paper , in order to understand their efficacy and long-term safety in reducing the risk of cardiovascular diseases .

AIM: To evaluate the changes of serum total prostate specific antigen (T-PSA), free prostate specific antigen (F-PSA) and the ratio of F-PSA to T-PSA (F/T) in patients with prostate cancer (PCa) and its clinical significance. METHODS: The concentrations of T-PSA and F-PSA in serum were measured by micropartical enzyme immunoassay (MEIA) using AxSYM System, and the F/T ratio was calculated. RESULTS: Before operation, the concentrations of T-PSA and F-PSA in patients with PCa were much higher and F/T ratio was significantly lower than that in patients with benign prostate hyperplasia (BPH). T-PSA and F-PSA levels decreased, but F/T ratio increased after operation in PCa and BPH. F/T ratio in 83.5% PCa and 6.5% BPH was less than 0.16. To diagnosis PCa, the sensitivity of F/T ratio was 83.5%, and the specificity was 86.7%. CONCLUSION: Serum T-PSA, F-PSA and F/T ratio are important parameters for the early diagnosis of prostate cancer. [

Objective To study the difference of body weight gain in the first and second trimesters between pregnant women with abnormal gestational glucose metabolism and those with normal gestational glucose metabolism.Methods We retrospectively analyzed the data of pregnant women visited the obstetric clinic of Peking Union Medical College Hospital from January 2010 to May 2011,with or without abnormal glucose metabolism.The data of body weight gain in the first and second trimesters,body mass index (BMI) before pregnancy,BMI in the end of second trimester,age,obesity history,diabetes family history,insulin level in the oral glucose tolerance test (OGTT),and lipid profile of these women were collected.Results Altogether 216 pregnant women with abnormal glucose metabolism (case group) and 230 pregnant women with normal glucose metabolism (control group) were included in this study.In the case group,the increment of body weight in the first and second trimesters was 10.0 (8.1,12.5) kg,and the increment of BMI was (4.01 ± 1.43) kg/m2,BMI in the end of the second trimester was (25.84 ± 3.14) kg/m2;in comparison,the increments of body weight and BMI in the first and second trimesters were 9.5 (7.0,11.5) kg and (3.60 ± 1.43) kg/m2,respectively,BMI in the end of the second trimester was (25.1 ± 3.00) kg/m2 in the control group,all significantly lower than in the case group (all P ＜ 0.05).The BMI before pregnancy was higher in the case group than in the control group [(21.84 ±2.99) kg/m2 vs.(21.50 ±2.82) kg/m2],but with no statistical significance (P＞0.05).Compare with the control group,the case group had older age [(33.17 ±3.65) years vs.(31.68±3.36) years],higher fasting insulin level [11.2 (7.1,16.3) mU/Lvs.8.9 (6.5,13.7) mU/L],higher peak insulin level in OGTT [135.3 (99.7,208.0) mU/L vs.104.9 (75.6,144.4) mU/L],higher homeostasis model assessment for insulin resistance (HOMA-IR) [2.40 (1.49,3.47) vs.1.82 (1.28,2.71)],and triglyceride [2.62 (2.04,3.31) mmol/L vs.2.18 (1.81,2.81) mmol/L],all with significant differences (all P ＜ 0.05).There were no significant differences in obesity history,family history of diabetes and history of menstrual disorder between the two groups (all P ＞ 0.05).Conclusions The body weight gain is higher in the pregnant women with abnormal glucose metabolism than in those with normal glucose metabolism in the first and second trimesters.Large increment of body weight is likely to be a risk factor for abnormal gestational glucose metabolism.

Objective To evaluate the application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung.Method Twenty eight patients with 31 pulmonary nodules of ground-glass opacity (GGO) detected by CT scan were admitted in our hospital from December 2008 to December 2013,including 17 males and 11 females with an average age of 55.The lesions were located by CT-guided Hook-wire technique,and lobectomy plus lymphadenectomy or pulmonary wedge resection were performed according to the results of fast frozen pathology.The characteristics of pulmonary nodules and general condition of the patients were analyzed.Results Among 31 nodules,19 were malignant and 12 benign with an average size of (1.8 ± 0.6) cm and thickness of (1.2-± 0.4) cm.The vertical distance from pleural to nodules was (1.5 ± 0.7) cm and the insert depth of needle was (2.5 ± 0.9) cm.The time for CT-guided Hook-wire localization was (16.5 ± 5.2) min.The operation time for pulmonary wedge resection and pulmonary lobectomy was (18.5 ± 5.5) min and (54.7 ± 12.5) min,respectively.Intraoperative frozen section showed malignant tumors in 18 patients (19 GGO nodules),lobectomy plus lymphadenectomy were performed in 16 cases; 2 patients did not undergo pulmonary lobectomy because of poor physical condition or 2 GGO nodules in different lobes.There were no operation complications in this series.Postoperative pathologic findings of 31 nodules showed 9 cases of adenocarcinoma,10 bronchioloalveolar carcinoma,5 atypical adenomatous hyperplasia,2 epithelioid hemangioendothelioma,2 chronic inflammation,1 hamartoma,1 inflammatory pseudotumor and 1 sarcoidosis.The average postoperative hospital stay was (6.6 ± 1.9) days.Conclusions Endoscopic resection of pulmonary GGO nodules with CT-guided Hook-wire localization technique is feasible and safe,with less complications and less time consuming.

Primary hyperparathyroidism (PHPT) in children is a rare condition,co-existing with vitamin D deficiency can lead to more diagnostic uncertainty.Here we report a case of a boy with PHPT complicated with vitamin D deficient rickets.The diagnosis and treatment of this patient was analyzed against literature review to summarize evidence-based clinical features of PHPT in children.We found that compared with adult PHPT,PHPT in children is associated with severer symptoms,higher serum calcium level,lower parathyroid hormone,preponderance of single adenoma in pathology,and higher cure rate of surgery.Co-existence of osteomalacia may induce reduction of the serum calcium level to the normal range,but cause more severe bone lesions.