Diabetes mellitus is a chronic metabolic disease with complications associated with long-term damage,dysfunction,and failure of various organs,and has become one of the leading causes of impairment of human health.At present,the prevalence of diabetes mellitus reaches 9.7%in China,which is considered one of the countries in the world with heavy diabetes burden.Patients with established diabetic complications will be at higher risk of poor health outcomes and with higsh healthcare costs.These realities support the critical need to identify diabetes and its precursors more efficiently and earlier.The current diagnostic criteria,fasting plasma glucose(FPG),and oral glucose tolerance test(OGYT),that require fasting and multiple blood samplings,may not be acceptable to patients and may limit the clinical application so as to impede the effort to diagnose diabetes in timely fashion.HbA1C,which accurately reflects longer term glycaemia,Can be done at any time without fasting or other preparation of the patient and may not be affected by short term lifestyle changes.Given the recognized need,some panels have been considering the possible utility of HbA1C as a supplementary screening tool to make the diagnosis of diabetes efficiently.

Although Addison's disease is uncommon, it may contribute to maternal and fetal morbidity and mortality if not treated appropriately. Clinical features, laboratory tests and endocrine function tests which conduce to diagnosis are reviewed. The long-term corticosteroid replacement therapy plays an important role in the treatment. Close monitoring during labor and postpartum, appropriate arrangement of corticosteroid could optimize the maternal and fetal outcome.

Impaired glucose regulation includes three types, isolated-impaired fasting glucose, isolated-impaired glucose tolerance and combined glucose intolerance.The epidemiologic studies and pathogenetic studies indicate that each type has different characteristics of insulin secretion and insulin sensitivity.The distinct metabolic features conduce to different early interventions in order to prevent or delay their progress to type 2 diabetes.

BACKGROUND:There is no common cognition in the cell type in the temporomandibular joint(TMJ)discs,and names describing TMJ disc cells also vary a lot.OBJECTIVE:To characterize the type and the distribution of cells in the TMJ disc of goats DESIGN,TIME AND SETTING:A single sample observation was completed in Cettutar and Motecutar Biologicat Center and Electron Microscope Center of Lanzhou University from March to May in 2007.MATERlALS:TMJ discs were obtained from two one-month-old healthy goats that were slaughtered freshly.METHODS:Bilateral TMJ discs of goats were cut off completely and were divided into 6 parts by 3 cuts in the major axis direction (mediolaterally)and 2 cuts in the minor axis direction(anteroposteriorly).Then the marked samples were fixed in 10%neutral formalin Iiquid for 24 hours and embedded by paraffin.MAIN OUTCOME MEASURES:Hematoxylin and eosin staining were used to identify regional variation of cell type and cellnumbers.Toluidine blue staining and collagen type Ⅰimmunohistochemical assay were performed to test the distribution of collagens.Transmission etectren microscopy was used to observe the ultrastructure of cells of goat TMJ discs.RESULTS:TMJ discs were comprised of cells and collagen fibers distributing unevenly.Collagens were mostly type Ⅰ.Collagen fibers were wave or crimping and approximately parallel to each other.with cells scattered in their matrix.Fibroblast-like cells and chondrocyte-like cells were the main two types of cells existing,with the former predominating over the later in a ratio of 2.05:1 approximately.There were no significant regional differences in cell type and distribution statistically.Transmission electron microscopy denoted that fibroblast-iike cells have fairly larger fusiform or irregular nuclei with very few organelles,while the chondrocyte-like cells exhibited round or elliptical nuclei,well defined pericellular electron lucent zones,unconspicuous cytocysta and non-distinctive pseudopodia CONCLUSION:There are no significant differences in type,number and arrangement of cells in TMJ discs of one-month-old goats statistically,with Fibroblast-like cells predominating slightly over chondrocyte-like cells.

Objective:To study the isolation, culture and identification of the TMJ cells and to observe the biological characteristics of cultured fibrochondrocytes. Methods:The TMJ discs were dissected from two 1 month goats under sterile conditions and were digested with collagenase. The cells were collected. Morphological changes and attachment efficiency were constantly observed under phase-contrast microscope. Immunohistochemical staining for type I collagen as well as toluidine blue staining were performed. Ultrastructures of the TMJ cells were observed under transmission electron microscope. Results: Most of the primary fibrochondrocytes presented a short spindle-shape while the rest showed polygon-shape. On the 7th day, the perliferating fibrochondrocytes started to contact each other to form a monolayer covering the bottom of the incubation disc. Immunohistochemical staining of type I and toluidine blue staining exhibited positive results. The fibrochondrocytes cytoplasms were rich in mictochondria and endoplasm reticulum. Conclusion: The fibrochondrcytes isolated from one-month-old goat TMJ disc have good proliferation ability in vitro and cells from passage 1 to 3 might be used as seed cells for TMJ disc tissue engineering.

Objective To investigate the prevalence and risk factors of metabolic syndrome (MS) in patients with type 2 diabetes in special care unit.Methods Two thousand three hunrded and sixty patients with type 2 diabetes were selected as our subject in The Sixth People's Hospital Affiliated to Shanghai Jiaotong University from Jan.2010 to Jul.2012.Among these patients,462 patients from special care unit were served as special care group and 1 898 patients from endocrinology ward were assigned to control group.The disease history information was recorded and physical examination and biochemical tests,including blood lipids,blood pressure,fasting glucose,glycosylated hemoglobin,serum insulin,C peptide were measured.Results (1) In special care group,there were 335 male (72.5％) and the prevalence of smoking,alcohol drinking and the proportion of the high income people were 40.5％,24.9％,76.6％ respectively,higher than that of control group (56.6％,24.6％,10.7％,12.7％ ;x2 =32.1,16.9,12.3,32.8 ;P ＜ 0.01).The body mess index (BMI),levels of waist circumference,alanine aminotransferase (ALT),gamma glutamyhransferase (γ-GT),triglyceride (TG),serum uric acid and fasting C peptide in special care group were ((25.6 ± 3.7) kg/m2,(91.0 ± 9.5) cm,(27.8 ±19.7) U/L,(34.1 ±26.3) U/L,(2.35 ±2.31) mmol/L,(333.7 ±85.5) μmol/L,(2.11 ±1.04) μg/L) higher than those of control group ((24.8 ± 3.5) kg/m2,(89.1 ± 10.3) cm,(23.0 ± 16.1) U/L,(29.2 ±23.2) U/L,(1.82 ±1.64) mmol/L,(317.1 ±85.2) μ mol/L,(1.74 ± 1.05) μg/L;F =11.44,6.90,16.65,8.35,18.23,7.34,21.21 ; P ＜ 0.01).The age,duration of diabetes,systolic blood pressure,level of serum high-density lipoprotein-cholesterol (HDL-C),and glycosylated hemoglobin were ((52.9 ± 11.1) years,5 (2,10) years,(126.7 ± 15.2) mmHg,(1.02 ± 0.32) mmol/L,(8.44 ± 1.99) ％) lower than those of control group((60.4 ± 12.2) years,7 (2,12) years,(131.9 ± 17.3) mmHg,(1.10 ± 0.32) mmol/L,(9.16 ±2.32)％;F =79.41,12.71,18.93,12.78,18.52; P ＜ 0.01); (2) The rate of overweight/obesity,dyslipidemia and MS prevalence rates in special care group were 55.6％,68.4％,60.2％,significantly higher than the control group(46.1％,52.9％,50.6％ ;x2 =7.59,18.76,7.18,P ＜ 0.01).While the prevalence of hypertension in special care group was significantly lower than control group(39.6％ vs 50.7％,x2 =10.15,P =0.01).There was on significant difference between male and female in term of the prevalence of the MS in the special care group(61.2％ vs 57.5％,x2 =0.01,P =0.92).According to age,patients in special care group were divided into three groups and that were ＜45 years group,45-59 years group and ≥60 years group.With the increase of age group of female,the prevalence of MS was increasing(33.3％,48.0％,74.1％ ;x2 =4.43,P =0.04).Among the male patients,there was no significant different was seen among three groups (58.8％,62.5％,55.6％ ;x2 =0.05,P =0.87).(3) Multiple Logistic regression analysis showed that the independent risk factors of MS in special care group including age(OR =1.071,95％ CI(1.027-1.117),P =0.01),BMI (OR =1.391,95％ CI(1.112-1.739) ; P =0.013),waist circumference (OR =1.126,95％ CI(1.039-1.222) ; P =0.004),TG (OR =1.747,95 ％ CI(1.124-2.717) ; P =0.013) and diastolic blood pressure (OR =1.111,95％CI(1.045-1.180);P =0.001).HDL-C(OR=0.048,95％CI(0.005-0.464) ;P =0.009) were protective factors of MS in special care group.Conclusion Approximately 3/5 patients with diabetes in special care unit got MS.The factors including age,BMI,waist circumference,diastolic blood pressure,TG,HDL-C were related to MS occurrence.

Subacute thyroiditis can cause destruction of thyroid follicles and subsequent transient thyrotoxicosis.In cases of simultaneous occurrences of subacute thyroiditis and Graves' disease,the former may be missed and thus may further exacerbate thyrotoxicosis.Herein,we report in detail a case with abrupt onset of thyrotoxic heart disease when taking anti-thyroid medications,in order to call attention to the diagnosis and treatment of concomitant Graves' disease and subacute thyroiditis.

Objective This study aimed to assess the effects of active and passive smoking on chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).Methods Seven hundred and five patients with T2DM were recruited in the study and were divided into three groups based on smoking status as active smokers,passive smokers and non-smokers.Twenty-four hour urinary albumin excretion (24hUAE) was measured,and estimate glomerular filtration rate (eGFR) was calculated with age and blood creatinine levels.Results (1) The proportion of CKD in T2DM in the present study was 31.63％ (223/705) with 28.6％ (22/77),30.0％ (15/50) and 29.6％ (73/247) for non-smokers,passive smokers and active smokers in men,and 29.9％ (40/134),35.9％ (66/184) and 7/13 for non-smokers,passive smokers and active smokers in women,respectively.In comparison with non-smokers,a higher risk of CKD was found in both passive and active smokers (OR =1.07 and OR =1.05 in men ; OR =1.31 and OR =2.74 in women,respectively).(2) Compared with non-smokers,passive smokers had a significant higher risk for albuminuria in women (OR =2.02,P =0.016).(3) After adjusting for gender,age,duration of T2DM,BMI,systolic blood pressure,glycosylated hemoglobin A1C and lipids,there was a significant decrease in eGFR between active and never smokers (P =0.018)or passive smokers (P =0.000) in women.No differences could be found in eGFR between each smoking statues in men.Conclusions Smoking exposure alone confers a high risk for CKD in patients with T2DM.Our results highlight an importance in implementation of a smoke-free environment for patients with T2DM.

Objective To evaluate the morphological changes of sural nerve in patients with type 2 diabetes mellitus by hyperfrequency ultrasound.Methods Fifty-six sural nerves of symptomatic group,64 sural nerves of asymptomatic group,and 60 sural nerves of control group were identified by 22 MHz Ultrasound.The thickness/width (T/W) ratio,cross-sectional areas (CSA) and the maximum thickness of neuronal fascicles (MT) of the sural nerve were calculated in transverse sonograms.Results ①Ultrasound can clearly show these structures of sural nerve such as epineurium,perineurium and nerve bundles and so on.②In symptomatic group,asymptomatic group and control group,T/W ratio and MT were gradually increased,and the differences among the three groups were statistically significant (P＜0.05).Whereas,there were no statistically significant differences in CSA among the three groups (P=0.257).Conclusions22 MHz ultrasound may be a valuable tool in evaluating the diabetic cutaneous nerve neuropathy

This paper introduces the nursing care of two children with type 1 diabetes during continuous glucose monitoring. In addition to psychological care,diet instruction and insulin therapy,the nurses actively communicated with the children and their parents,introduced the principle and advantages of continuous glucose monitoring system (CGMS) to promote the children and parents to cooperate with the medical staff. Moreover,the insert site of CGMS was changed from inferior abdomen to up-per lateral buttock according to the physiological character of children. As a result,the CGMS was completed successfully in the 2 eases,which provided reliable reference for the regulation of treatment plan.