Objective To analyze the differences of nutritional parameters and body composition in the protein energy wasting (PEW) patients on maintenance hemodialysis with or without diabetic kidney disease (DKD).Methods The patients with PEW were screened by subjective global assessment (SGA) from patients on maintenance hemodialysis from March 2014 to June 2015 in the Fourth Central Hospital of Tianjin.Anthropometric and nutritional parameters were collected before dialysis, and body composition and energy expenditure were examined by the bioelectrica] impedance method.The indexes of the two groups were compared.Results A total of 301 patients on maintenance hemodialysis (DKD 112, non-DKD 189), whose average age was (63.05±14.42) years old, were screened.Among which, 75 patients were diagnosed with PEW, and the overall prevalence rate was 24.92％, including 41 DKD cases with the prevalence of 36.61％ (41/112) and 34 non-DKD cases with the prevalence of 17.99％ (34/189).Compared with uon-PEW patients, the body mass index (BMI), hemoglobin (Hb), albumin (ALB), and total cholestero (TC) of patients with PEW were significantly lower, and C-reactive protein (CRP) were significantly higher (P＜0.05).In the DKD group, the average age of PEW onset ((59.61±13.74) years old), the maintenance dialysis time before PEW ((64± 12.50) months), ALB ((31.34±3.32) g/L), and TC ((4.17±0.95) mol/L) were all lower than those in the non-DKD group ((70.68±14.05) years old, (116.61 ±32.85) months, (32.34±4.64) g/L, (4.95±1.52) mol/L) (P＜ 0.05), respectively.The body composition results showed that muscle mass in the DKD group ((24.84±3.36) kg/ (45.32±6.95)％) was less than that of the non-DKD group ((28.53±3.75) kg/(50.67±7.28)％) (P＜0.05).Conclusions This study indicates that compared with non-DKD dialysis patients, the prevalence of PEW in dialysis patients with DKD is higher, onset age of PEW is younger, the duration of dialysis is shorter, and the muscle consumption is more obvious.

Objective To explore the correlation between socioeconomic status (SES) and mortality of patients with diabetic kidney disease (DKD) on hemodialysis by using a retrospective cohort study.Methods Cases with DKD on hemodialysis in the Fourth Central Hospital of Tianjin from Jan.2006 to Mar.2010 were retrospectively reviewed.SES, including education, the average monthly income of household members, occupation type, was surveyed among all the patients.According to the SES, the patients were divided into two groups.The 1-year, 3-year, and 5-year mortality rates of the two groups were compared respectively.Relative risk (RR), attributable risk (AR) and attributable risk percentage (ARP) were calculated.Further, the relevance of SES and other variables were analyzed.Results The baseline of two groups in age, sex, duration of diabetes, kidney disease progression was consistent and comparable.In the low SES group, 1-year death RR was 1.08, AR was 1.5％ and ARP was 8.1％.Three-year death RR was 1.38, AR was 10.9％ and ARP was 27.6％.Five-year death RR was 1.57, AR was 24.5％ and ARP was 36.4％.Correlation analysis showed that SES scores were negatively correlated to body mass index (BMI), glycated hemoglobin (HbA1c) and C-reactive protein (CRP) (r=-0.542,-0.314,-0.392, P＜0.01), while SES scores were positively correlated to serum albumin (ALB), physiological function, general health, social function, emotional function and mental health scores (r=0.539, 0.243, 0.254, 0.268, 0.253, 0.255, P＜0.01).Conclusions SES is an important social-influencing factor of mortality in patients with DKD,and may have effects on long-term survival of hemodialysis patients by influencing the quality of life, glycemic control, nutrition and inflammation.

Objective To assay the plasma omentin level in patients of type 2 diabetes mellitus (T2DM) combined with non-alcoholic fatty liver disease (NAFLD) and investigate the relationship between plasma omentin level,glucose and lipid metabolism,insulin resistance and NAFLD.Methods The plasma omentin level was assayed by enzyme-linked immunosorbent assay(ELISA) in all subjects,including patients of T2DM controls with NAFLD (group A,50 cases),T2DM without NAFLD (group B,50 cases),simple with NAFLD(group C,51 cases) and normal controls (group D,49 cases).Meanwhile,blood glucose,glycosylated hemoglobin(HbA1c),lipids and insulin levels were also measured.Body mass index (BMI) and waist-to-hip ratio were evaluated.Insulin sensitivity was assessed by HOMA-IR.Results The plasma omentin level was (17.85 ±3.68),(13.89 ±10.68),(26.05 ±7.26) and (22.92 ±2.71)μg/L in group A,B,C and D respectively.The plasma omentin level of group A and group B was significantly lower than that of group C and group D(P ＜ 0.05).The plasma omentin level of group A was higher than that of group B (P ＜ 0.05).The plasma omentin level of group C was higher than that of group D (P＜ 0.05).Correlation analysis showed that the plasma omentin level was negatively correlated to weight,BMI,waist,triglyceride,fasting blood glucose,fasting insulin (FINS) and HOMA-IR (P ＜0.05 or ＜0.01),and positively correlated to high-density lipoprotein cholesterol (HDL-C)(P ＜0.01).Multiple stepwise regression analysis showed that BMI,HOMA-IR and FINS was independent variable of omentin.The concentration of omentin was 24.82 μ g/L which could predict the risk of NAFLD in people with normal glucose regulation.Conclusions The plasma omentin level is closely correlated with glucose,lipid metabolism and insulin resistance.Plasma omentin may play an important role in the pathogenesis of T2DM and NAFLD.

Objective To investigate the relationship between plasma soluble CD36 (sCD36) and nonalcoholic fatty liver disease (NAFLD) in patients combined with type 2 diabetes mellitus (T2DM). Methods Plasma levels of sCD36 were determined in normal control group (group A, n=39), patients of T2DM without NAFLD group (group B, n=39) and T2DM with NAFLD group (group C, n=59). Liver fat content (LFC) and nonalcoholic fatty liver fibrosis score (NFS) were calculated in group C. Glucose and lipid metabolic parameters, liver function parameters and inflammatory parameters were also detect?ed in all three groups. Variance analysis was applied to analyze the differences of the above parameters among three groups;Correlation analysis was used to analyze the relationship between sCD36 level and all the above parameters;Multiple step? wise regression analysis was applied to determine the influencing factors of sCD36 level in patients of group C. Results Plasma sCD36 (μg/L) levels in group B (3.87 ± 1.16) and group C (5.72 ± 1.79) are higher than that of group A (2.57 ± 0.93) (both P<0.01), and it is higher in group C than in group B (each P<0.05);Correlation analysis showed that sCD36 level was positively correlated with body mass index (BMI), waist, visceral adipose tissue,fast insulin (FINS), insulin resistance in?dex (HOMA-IR), free fatty acid (FFA), alanine transaminase (ALT), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), LFC and NFS (P<0.01 or P<0.05);Multiple stepwise regression analysis showed that FFA, LFC, TNF-αand IL-6 were in?fluencing factors of sCD36 level in patients of group C. Conclusion Plasma sCD36 level was related to fatty liver severity, liver injury and fatty liver fibrosis, it might be used as a plasma marker of T2DM combined with NAFLD. CD36 might con?tribute to the development of T2DM combined with NAFLD through inflammatory mechanisms.

Objective To study the relationship between advanced liver fibrosis and peripheral neuropathy in patients with type 2 diabetes mellitus (DPN). Methods A total of 173 patients (89 men and 84 women) with type 2 diabetes who hos?pitalized in Tianjin Third Central Hospital within nearly three years (2013.02-2015.02) were divided into three groups ac?cording to non-alcoholic fatty liver disease (NAFLD) fibrosis score:group A (NFS≤-1.455), group B (-1.455

Objective To evaluate the role of adrenal venons sampling (AVS) in differential diagnosis of subtypes in primary aldosteronism.Methods Twenty-two patients diagnosed as primary aldosteronism in the Third Central Hospital of Tianjin from November 201 1 to July 2014, were undergone AVS for measurement of plasma aldosterone and cortisol levels in each adrenal vein and infrarenal inferior vena cava.The data were compared with the results of the thin slice incremental scanning in adrenal and postoperative pathologic diagnosis.Other 8 patients, whose screening test and confirmed diagnosis did not support the primary aldosteronism, with nodule larger than 4 cm pathologically confirmed as non-functioning adrenal adenoma, were also recruited.Results Among all the 22 patients with primary aldosteronism, the incidence rate of hypertention was 95.4％, and the incidence of hypokalemia was 81.8％.Compared with idiopathic hyperaldosteronism patients, the patients with aldosterone producing adenoma had higher blood pressure and aldosterone level in plasma, but lower plasma potassium, while the clinical and biochemical index of the non-functioning adrenal adenoma group were within the normal range.The overall accuracy rate of adrenal CT in the diagnosis of subtypes of primary aldosteronism was 77.27％ (17/22), and the accuracy rates were 78.95％ (15/19) in aldosterone producing adenoma and 66.7％ (2/3) in idiopathic hyperaldosteronism, respectively.The accuracy rate of AVS was 100％ with the ratio of aldosterone to cortisol as the criterion.Conclusions Misdiagnose may occur when using CT scan only to differentially diagnose primary aldosteronism.Compared with CT imaging of the adrenal glands, AVS has higher coincidence rate and is an elective approach to establish the subtype diagnosis of questionable primary aldosteronism.

Objective To investigate the relationship of omentin-1 with adiponectin and inflammatory cytokines in type 2 diabetes (T2DM) patients with nonalcoholic fatty liver disease (NAFLD). Methods The serum levels of omentin-1 and adiponectin were assayed by enzyme-linked immunosorbent assay (ELISA) in patients of T2DM with NAFLD (group A, n=63), T2DM without NAFLD (group B, n=63)and normal control group (group C, n=70). At the same time the biochemical markers and inflammatory marker, such as tumor necrosis factor (TNF)-α, high-sensitivity C-reactive protein (hs-CRP) and interleukin 6(IL-6) were detected in three groups. The correlation analysis and multiple regression analysis were used to de-tect the association of omentin-1 with adiponectin and inflammatory markers. The logistic regression was used to analyze fac-tors influencing NAFLD in patients with T2DM. Results The serum levels of omentin-1 and adiponectin were significant-ly lower in group A [ (27.02±2.82)μg/L and (11.98±3.63) mg/L] than those of group B [(31.52±2.81)μg/L and (15.85±3.28) mg/L] and group C [(35.92±2.80)μg/L and (19.88±3.44) mg/L], and there were significantly lower levels of them in group B than those of group C (P<0.01). The plasma omentin-1 level was positively correlated with adiponectin and high density li-poprotein (HDL-C) in group A. Also the plasma omentin-1 level was negatively correlated with TNF-α, IL-6, fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), visceral adipose tissue, waist, waist-to-hip ratio (WHR) and free fatty acid in group A (P<0.05 or P<0.01). Multiple stepwise regression analysis showed that adipo-nectin, TNF-αand IL-6 were independent factors influencing the level of plasma omentin-1. Logistic regression analysis showed that omentin-1 was one of independent factors influencing T2DM combined with NAFLD (P<0.01). Conclusion The incident of NAFLD in T2DM patients is related to the lower level of omentin-1, which may be influenced by adiponectin and inflammatory factors.

Objective To investigate the relationship between plasma levels of chromogranin A (CHGA) and adi-pose triglyceride lipase (ATGL) in patients with type 2 diabetes (T2DM) combined non-alcoholic fatty liver disease (NAFLD). Methods The plasma levels of CHGA and ATGL were assayed by enzyme-linked immunosorbent assay (ELISA) in T2DM patients with NAFLD (group A, n=74), T2DM without NAFLD (group B, n=76), and normal group (group NC, n=75). The correlation between CHGA, ATGL and other metabolic index was analyzed. Results The plasma level of CHGA was significantly higher in group A (83.15±9.46) and group B (70.90±2.75) than that of group NC (46.74±8.15, P<0.01), and the level of CHGA was significantly higher in group A than that of group B (P<0.01). The plasma level of ATGL was sig-nificantly lower in group A (21.36±13.42) and group B (40.29±22.83) than that of group NC (72.30±26.41, P<0.01), and the level was lower in group A than that of group B (P<0.01). There was a negative correlation between the plasma CHGA, AT-GL and carbohydrate oxidation rate in group A. There was a positive correlation between fasting insulin (FINS), insulin resis-tance index (HOMA-IR), free fatty acid (FFA) and fat oxidation rate in group A. There was a negative correlation between plasma level ATGL and body mass index (BMI), FINS, cholesterol (TC), triglyceride (TG) and HOMA-IR, meanwhile, it was positively correlated with FFA. The multiple stepwise regression analysis showed that FINS, ATGL and FFA were indepen-dent variables for CHGA. The Logistic regression analysis showed that plasma levels of CHGA, ATGL and FFA were the in-dependent predictors of T2DM with NAFLD. Conclusion The plasma levels of CHGA and ATGL are closely correlated with substance and energy metabolism, and the interaction between them may play an important role in the pathogenesis of T2DM with NAFLD .

OBJECTIVETo explore the relationship between socioeconomic status (SES) and non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).

METHODSThe medical records of Tianjin Third Central Hospital were retrospectively reviewed to identify patients who had been hospitalized for treatment of T2DM but without diagnosis of NAFLD between 2007 and 2012 and who had required a second hospitalization during this same period. Each patient was contacted by telephone for self-reporting of SES. Analysis was carried out with patients grouped according to SES (high vs. low) to determine association of SES with incidence of NAFLD at the second hospitalization; the relative risk (RR), attributable risk (AR) and attributable risk percent (ARP) were calculated. Furthermore, the correlation of SES with other clinical and socio-psychological variables was assessed.

RESULTSThe patients in the high and low SES groups showed no significant differences at baseline. For development of NAFLD by the time of the second hospitalization, the low SES group had an RR of 2.19, an AR of 20.74%, and an ARP of 54.39%. Correlation analysis showed that SES was positively correlated with body mass index (r=-0.582) and levels of glycated hemoglobin (r=-0.421), fasting serum insulin (r=-0.570), insulin resistance (as assessed by the HOMA method) (r=-0.487), low-density lipopmtein (r=-0.396) and C-reactive protein (r=-0.353) (all P<0.05), and negatively correlated with high-density lipopmtein (r =0.539) and with the scores for physical functioning (r =0.241), general health (r=0.234), social functioning (r =0.286), emotional health (r=0.251), and mental health (r=0.215) (all P<0.05).

CONCLUSIONSES is an influencing factor of NAFLD in patients with T2DM and is closely related to obesity, insulin resistance, lipid metabolic disorder, chronic inflammation and life quality in patients with NAFLD and T2DM.

Objective To investigate early diagnosis and treatment of Paget disease of breast. Methods The clinicopathological data of 26 cases of breast Paget disease in the First Affiliated Hospital of Wenzhou Medical University from January 1995 to June 2018 was analyzed. Results The main clinical manifestation of 26 patients was eczema like papillae in 19 cases (73.1%), and associated with nipple discharge in 9 cases (34.6% ) and breast mass in 6 cases (23.1% ). The diagnosis of this disease was based on curettage cytology in 4 cases (15.4% ), biopsy in 8 cases (30.8% ), and needle aspiration cytology or post resection pathological examination in 14 cases (53.8% ). Paget disease consisted of simple papillary Paget disease in 3 cases (11.5%), ductal carcinoma in 18 cases (69.2%) and invasive ductal carcinoma in 5 cases (19.2%). Pathological TNM staging was 0 stage in 19 cases (73.1%), stageⅠin 3 cases (11.5%), stageⅡin 2 cases (7.7%), stageⅢin 2 cases (7.7%) and no stage inⅣcase. In this group, 2 cases underwent radical mastectomy, 18 cases underwent modified radical mastectomy, 4 cases underwent simple mastectomy, and 2 cases underwent mastectomy combined with low axillary lymph node dissection and intraoperative rapid frozen examination. Fourteen patients received adjuvant chemotherapy with CEF(cyclophosphamide + pharmorubicin + tegafur)/EC (pharmorubicin + cyclophosphamide) + T(docetaxel) or TP(docetaxel + cis- platinum)regiment after operation, 2 cases were treated with trastuzumab targeted therapy and 5 cases with adjuvant radiotherapy. Twenty-five of 26 patients were followed up for 8-108 months except one patient lost in follow-up. The 5-year survival rate was 96.0% (24/25), and the 10-year survival rate was 52.0% (13/25). Conclusions The diagnosis of Paget disease of the breast depends on cytology or pathology, and multidisciplinary treatment based on surgery is judged of by tumor stage and coincident other types of breast cancer and axillary lymph node involvement.