Osteocalcin is a bone matrix noncollagen protein which is one of the most abundant secretory products of osteoblasts. Resent studies have demonstrated that osteocalcin is not only a specific biochemical marker of bone turnover, but also involved in the regulation of energy metabolism. Further studies in the pathophysiological functions of osteocalcin might contribute to the treatment of obesity, diabetes, and metabolic syndrome.

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:To study the relation between the costimulating molecules CD40,CD80 on DC and their antigen presentation function in patients with chrnic HBV infection .Methods:The DC from healthy donors and patients were stained with anti human specific mouse monoclonal antibodies conjugated with fluorescein isothiocyanate(FITC) respectively.Mouse McAb used were anti HLA ABC,HLA DR,CD1a,CD14,CD40,CD80.Results:There are no remarkable difference in MHC I?MHC II between two groups;remarkable difference was showed in CD40(P

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) till August 2014.Measurement data with normal distribution were presented as average (range).Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes).Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days).All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.

To investigate the relationship between serum glutamic acid decarboxylase antibody (GAD-Ab)titer and the first-phase insulin release (1PH)in newly-diagnosed type 2 diabetic patients. 1053 newly-diagnosed type 2 diabetic patients were divided into 3 groups, including 71 individuals with GAD-Ab≥1 U/ml (positive group), 171 individuals with GAD-Ab ranging from 0 to 1 U/ml (negative-1 group), and 811 individuals with GAD-Ab=0 (negative-2 group). IPH was evaluated by arginine stimulation test. In the patients of negative-2, negative-1, and positive groups, the respective values of 1 PH were subsequently decreased significantly (P< 0. 01) , and the detection rates of the decreased insulin secretion were 74. 85%, 87. 13%, and 100%, respectively. Stepwise regression analysis indicated that disease duration, GAD-Ab titer, HbA_1C, and body mass index were the major independent contributing factors. The titer of GAD-Ab has an important impact on 1PH defect in type 2 diabetic patient. Detection of GAD-Ab not only provides an evidence for clinical type, but would also be helpful in determining the islet β-cell function.

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.

Objective To analyze the clinical characteristics of coronary artery disease (CAD) in patients with nonalcoholic fatty liver disease ( NAFLD). Methods Totally 234 subjects underwent coronary angiography, including 148 men and 86 women with complete data on metabolic syndrome ( MS) and abdominal ultrasonography; the mean age was 66. 6 years. The severity of CAD was assessed by coronary stenosis index (CSI). Metabolic syndrome was diagnosed according to the Guideline on Prevention and Treatment of Blood lipid Abnormality in Chinese Adults. Results Ultrasonography revealed that 62 patients had NAFLD (26. 5%). In patients with NAFLD, the prevalence of central obesity was higher than those without NAFLD (75. 8% vs 50. 0% , P< 0.01). With regards to age, CAD patients with NAFLD were more common in patients under 60 years (27.4% vs 13.7% , P=0.005). CSI score was similar in CAD subgroup and CAD & NAFLD subgroup (P>0.05), however the age of patients in CAD & NAFLD subgroup was significantly lower compared to CAD subgroup ( P = 0.006). According to the results of logistic regression, central obesity was the independent risk factor of NAFLD (β= 1.701, P<0.001). Logistic regression demonstrated that age was independently associated with CAD (β = 0.032, P=0.027). Further more, multiple stepwise regression analysis showed that age was the single parameter that best predicted CSI score (β= 0. 125, P = 0. 022). Conclusions It is important to screen coronary artery disease in middle aged patients with central obesity or NAFLD.