Adults-onset nesidioblastosis,as a differential diagnosis of organic hyperinsulinemic hypoglycemia,is very rare and has been recognised as "noninsulinoma pancreatogenous hypoglycaemia syndrome(NIPHS)".Here we described an extremely rare case of NIPHS in an eldly type 2 diabetes mellitus with insulin therapy.A 84-year old male was diagnosed as type 2 diabetes six years ago and switched from an oral hypoglycemic drug to pro-mixed insulin treatment 3 years ago.According to medical records,he had good-glucose control over few hypoglycemia.He was admitted to hospital due to frequent fasting hypoglycaemic episodes and comas despite withdrawal of any anti-diabetes drugs and continous infusion of homogenate meal at night.Lab test showed low fasting glucose level and inappropriate high insulin/C-peptide level,and anti-insulin antibody was negative.A characteristic of hyperinsulinemic hypoglycemia with high C-peptide level was consistent with the possible diagnosis of insulinoma,but localizing studies including computed tomography of the abdomen and somatostatin receptor scintigraphy were negative.Surgical exploration by the palpation and intraoperative ultrasonography failed to detect any mass in the pancreas and 70% distal pancreatectomy was performed.Histological examination of the resected pancrease revealed an increased number and size of islets consistent with nesidioblastosis.After transient decline,his serum insulin travelled back to the level before pancreaectomy,but recurrent fasting hypoglycemia was mild and controlled by regular night eating postpancreaectomy.Abstract:SUMM ARY Adults-onset nesid ioblastosis,as a d ifferential d iagnosis of organic hyperinsulinem ic hypo-glycem ia,is very rare and has been recognised as"noninsulinoma pancreatogenous hypoglycaem ia syn-drome(NIPHS)".Here we described an extremely rare case ofNIPHS in an eldly type 2 d iabetesmelli-tus with insulin therapy.A 84-year old male was d iagnosed as type 2 d iabetes six years ago and switched from an oral hypoglycem ic drug to pro-m ixed insulin treatment 3 years ago.Accord ing tomed ical records,he had good-glucose control over few hypoglycem ia.He was adm itted to hospital due to frequent fasting hypoglycaem ic episodes and comas despite withdrawal of any anti-d iabetes drugs and continous infusion of homogenate meal at night.Lab test showed low fasting glucose level and inappropriate high insulin /C-peptide level,and anti-insulin antibody was negative.A characteristic of hyperinsulinem ic hypoglycem ia with high C-peptide level was consistentwith the possible d iagnosis of insulinoma,but localizing stud ies includ ing computed tomography of the abdomen and somatostatin receptor scintigraphy were negative.Surgical exploration by the palpation and intraoperative ultrasonography failed to detect any mass in the pancreas and 70% d istal pancreatectomy was performed.H istological exam ination of the resected pancre-ase revealed an increased number and size of islets consistent with nesid ioblastosis.After transient de-cline,his serum insulin travelled back to the level before pancreaectomy,but recurrent fasting hypoglyce-m ia was m ild and controlled by regular night eating postpancreaectomy.

Objective To investigate the current situation of caregiver burden of relative caregivers of multiple myeloma patients, and to analyze its influencing factors. Methods Cross-section investigation method was used in the study. A total of 125 multiple myeloma patients and their relative caregivers, who accepted treatment in the hematology department of He'nan Provincial People's Hospital from December 2015 to March 2017 were selected by convenience sampling method. The general situation investigation questionnaire, Zarit Caregiver Burden Inventory (ZBI), Barthel Index (BI), Social Support Rating Scale (SSRS) and Connor-Davidson Resilience Scale (CD-RISC) were adopted in the investigation. PASW 18.0 software was adopted for statistical analysis of the data. Results The ZBI score of the relative caregivers of multiple myeloma patients was (57.01±15.36), and 86.4% of the caregivers' scored at a moderate level and over. The differences of ZBI scores of the caregivers with different educational background, family average monthly income, caring time and the different numbers of complications in patients were statistically significant (t/F/H=3.924,9.656,8.062,20.608;P< 0.05). The average score of BI in multiple myeloma patients was (53.56±8.30), with moderate dysfunction, which was negatively correlated with the total score of ZBI and the scores of its all dimensions (P< 0.01). The average score of SSRS in the caregivers was (48.18± 8.53), with a high level of social support, and the average score of CD-RISC was (64.50±9.41), the two of which were both negatively correlated with the total score of ZBI and the scores of its all dimensions (P<0.05). As indicated by the results of multiple linear regression analysis, the complication number and self-care ability of the patients as well as the average monthly family income, caregiving time, social support and mental elasticity of the relative caregivers could be included in the regression equation, which explained 40.1% of the variance. Conclusions The caregiver burden of patients with multiple myeloma is relatively heavy. The complication number and self-care ability of the patients as well as the average monthly family income, caregiving time, social support and mental elasticity of the relative caregivers are the influencing factors of caregiver burden.

Cellular dysfunction caused by vesicle transport is associated with a variety of diseases.The trans-Golgi network(TGN)to endosome transport is an important pathway of vesicle transport,and its defects leading to protein balance disorders has been linked to many diseases such as cancer,neurodegenerative diseases and diabetes mellitus.Gol-gi-associated gamma-adaptin ear-containing ADP-ribosylation factor-binding protein 2(GGA2)is a crucial protein in-volved in TGN-endosomal transport.It plays a significant role in the regulation of several diseases,including cancer,Al-zheimer disease,type 2 diabetes mellitus and cerebral ischemia,by mediating protein transport with important biological significance.This article provides an overview of the molecular structure of GGA2,its role in regulating clathrin-mediated protein transport between TGN and endosomes,and its potential implications for a variety of diseases.