Objective:To study the differentially expressed genes associated with lipid metabolism in adipose tissues of patients with insulin resistant(IR) type 2 diabetes mellitus(T2DM),in an effort to explore the mechanism of IR.Methods: mRNA from the omental adipose tissues of T2DM patients(n=5) and normal controls(n=5) were reversely transcribed into cDNAs with the incorporation of fluorescent dUTP(cy-5 or cy-3) to prepare hybridization probes.The mixed probes were hybridized with a cDNA microarray containing the target genes.The results were scanned and subjected to computer analysis to search for the difference between the gene spectrum of T2DM patients and normal controls.The differentially expressed gene,FOXC2,was verified by Northern blot.Results: Eighty-two differentially expressed genes were identified between these 2 groups,with 10 associated with lipid metabolism,including 5 upregulated ones and 5 downregulated ones.Northern blotting confirmed that the expression of FOXC2 mRNA was increased in IR group,which was in accordance with the result of cDNA microarray analysis.Conclusion: The pathogenesis of IR is related with lipid metabolism and the FOXC2 gene may be a candidate gene of(IR. )

0.05)in sex,age and volume of lesions.Over a course of treatment the average volume of thyroid adenomas of each group significantly(P

Objective To evaluate the clinical efficacy of thalidomide plus mometasone furoate cream under occlusion and ultraviolet irradiation for the treatment of prurigo nodularis.Methods A non-randomized,parallel,controlled study was carried out.Eighty patients with prurigo nodularis were divided into 3 groups,i.e.,control group(no irradiation),ultraviolet A1(UVA1)group,and ultraviolet B(UVB)group.All the patients were treated with oral thalidomide and topical mometasone furoate cream under occlusion.Additionally,the patients in UVA1 group and UVB group received UVA1 and NB-UVB irradiation,respectively,thrice a week for no less than 8 weeks.Patients were evaluated at the baseline,and on day 30 after the beginning of treatment.Clinical outcome parameters included disease severity score and visual analogue scales for pruritus.Peripheral blood eosinophils were counted during each visit.Rank sum test was performed to compare the clinical efficacy between the 3 groups,and the relationship between peripheral blood eosinophile count and visual analogue scales for pruritus was analyzed.Results After 30 days of treatment,skin lesions were markedly improved in 5 (21.74％),13(43.33％)and 9(37.5％)patients,and improved in 7(30.43％),12(40％)and 7(29.17％)patients,in the control group,UVA1 group and UVB group respectively;a marked response in pruritus was noted in 7(30.43％),18(60.00％)and 14(58.33％)patients respectively in the control group,UVA1 group and UVB group.The efficacy on skin lesions and pruritus was significantly stronger in the UVA1 group and UVB group than in the control group(skin lesions:Z =8.21,5.22,both P ＜ 0.01;pruritus:Z =4.50,4.50,both P ＜ 0.01),but similar between the UVA1 group and UVB group(skin lesions:Z =0.50,P ＞ 0.05;pruritus:Z =0.35,P ＞ 0.05).Peripheral blood eosinophil count was positively correlated with the visual analogue scale for pruritus in the patients(r =0.53,P ＜ 0.01).Conclusions Thalidomide combined with mometasone furoate cream under occlusion and ultraviolet irradiation shows notable efficacy for the treatment of prurigo nodularis,and the combination with UVA1 or NB-UVB irradiation enhances the efficacy of thalidomide and mometasone furoate cream under occlusion.

Student as standard patient(SSP) was defined as student receiving relative medical training,who was willing to act as a human analogue as a patient and could be used as not only a patient but also a teacher in clinic practice.The results indicates that the using of SSP in the clinical teaching of endocrinology could promote the students'level in practice and in the meanwhile,it could be useful to testing the learning result.

The knowledge of endocrine metabolic diseases represented by type 2 diabetes mellitus is highly specialized, complicated, and has many clinical guidelines. In this context, team based learning teaching combined with case teaching based on evidence-based medicine was applied in the actual class teaching. The class was divided into several groups and the students were encouraged to discuss and study from each other with the guidance of teachers. Consequently, students' learning interests and spirit of team-work were greatly enhanced, the way of thinking using evidence-based medicine and their ability to solve the practical clinical problems were also improved.

ObjectiveTo evaluate the safety and efficacy of 30 mg pioglitazone hydrochloride combined with sulphonyurea in the treatment of type 2 diabetic patients.MethodsA randomized, double blind, placebo-controlled, parallel group, multicenter study was performed.A total of 236 patients, who had fasting plasma glucose(FPG) 7.5-13.0 mmol/L and glycosylated hemoglobin A1c(HbA1 c) 7.0％ -12.0％,treated with stable dosage of a sulphonyurea for at least 30 days previously, were randomized to receive placebo or pioglitazone 30 mg once daily for 16 weeks.The sulphonyurea and dosage remained unchanged.ResultsThe patients who had been treated with pioglitazone 30 mg showed significant decrease than that in the placebo group on the average from baseline in FPG [(1.48 ±2.08) mmol/L vs (-0.17 ± 1.92)mmol/L, P＜0.05], and in HbAlc [(0.92 ±0.10)％ vs (0.28 ±0.11)％, P＜0.05].Since fasting plasma insulin (Flns) levels decreased (0.24 ±0.04) mU/L and (0.09 ±0.04) mU/L in the two groups.The homeostatic model assessment insulin resistant (HOMA-IR) decreased 1.42 ± 2.90 and 0.46 ± 3.53 in two groups.The triglyceride level was decreased 0.36 mmol/L and 0.14 mmol/L, and the HDL-C level increased 0.17 mmol/L and 0.05 mmol/L in two groups.There were significant differences in two groups (all P ＜ 0.05).ConclusionsThe 16-week clinical study demonstrated that pioglitazone hydrochloride with a dosage of 30mg daily, could significantly improve the blood glucose control and enhance the insulin sensitivity, lower triglyceride and raise HDL-C level as an additional therapy to a stable-dose sulphonyurea in Chinese type 2 diabetic patients previously poorly controlled by single sulphonyurea therapy, and furthermore had good safety and compliance.

Objective To explore the value of predictive nursing of elderly patients with se-vere myocardial infarction.Methods A total of 56 patients with severe myocardial infarction ran-domized into study group and control group with 28 cases in each group.The control group used conventional nursing,including symptomatic in nursing after adverse psychology,complications and constipation,and study group applied predictive nursing including closely monitoring and pre-vention of adverse psychology and various complications on admission.Results The incidence of complications,constipation and mortality in the study group was significantly lower than that in the control group ,the differences between the two groups were statistically significant (P <0.05).The depression scores and anxiety scores were significantly lower than that in the control group,which indicated that the psychological state in the study group was better than that in the control group,the difference was statistically significant (P <0.01).Conclusion It is of great value for the elderly patients with severe myocardial infarction applied predictive nursing and it can reduce the incidence of complications,constipation and mortality,and help patients to maintain good metal status.

Objective To explore the value of predictive nursing of elderly patients with se-vere myocardial infarction.Methods A total of 56 patients with severe myocardial infarction ran-domized into study group and control group with 28 cases in each group.The control group used conventional nursing,including symptomatic in nursing after adverse psychology,complications and constipation,and study group applied predictive nursing including closely monitoring and pre-vention of adverse psychology and various complications on admission.Results The incidence of complications,constipation and mortality in the study group was significantly lower than that in the control group ,the differences between the two groups were statistically significant (P <0.05).The depression scores and anxiety scores were significantly lower than that in the control group,which indicated that the psychological state in the study group was better than that in the control group,the difference was statistically significant (P <0.01).Conclusion It is of great value for the elderly patients with severe myocardial infarction applied predictive nursing and it can reduce the incidence of complications,constipation and mortality,and help patients to maintain good metal status.

Objective To evaluate efficacy and safety of acarbose compared with metformin as add-on therapy in patients with type 2 diabetes mellitus inadequately controlled with insulin. Methods This was a randomized, open-labeled, and parallel group study. Ninety-one type 2 diabetic patients ( HbA1C7.5%-11.0%) who were suboptimally controlled despite receiving twice daily injection of insulin (30-60 U/d for at least 8 weeks) were enrolled. They were randomly assigned 1 ∶ 1 ∶ 1 to continuation of insulin, insulin with acarbose (Ins+Aca), and insulin with metformin (Ins+Met) groups to insulin treatment. The levels of HbA1C, oral glucose tolerance test, blood lipids etc were measured at baseline and 12 weeks, and adverse events were recorded. Results The mean HbA1C levelsdecreasedfrom(7.9±0.4)%atbaselineto(7.0±0.3)%atweek12(P＜0.01)intheIns+Acagroupand(7.8 ±0.2)%to(7.0±0.3)%in the Ins+Met group(P＜0.01), while no significant change in HbA1Cin the insulin alone group. Adding acarbose to insulin resulted in similar reductions in HbA1Crelative to metformin (P＝0.431). The achievement rate of HbA1Cbelow 7.0%at week 12 was the same(both 70%) between the Ins+Aca group and the Ins+Met group. Insulin combined with acarbose in improving blood glucose fluctuation effect was more significant than that incombinationwithmetformin(P＜0.01),withstandarddeviation(SD)ofbloodglucose[(1.1±0.5vs2.7±0.6) mmol/L, P＜0.01], postprandial blood glucose fluctuations [(0.5 ± 0.7 vs 2.8 ± 0.4) mmol/L, P＜0.01], the maximumbloodglucosefluctuations[(2.8±0.7vs4.6±0.6)mmol/L,P＜0.01].Theweightlossoccurredinboththe Ins+AcaandtheIns+Metgroups[-(0.5±0.8vs1.0±0.4)kg].Therewasnosignificantchangesinbloodpressure and lipid profile. Hypoglycemic episodes were comparable in all groups. No serious adverse event was noted in any group. Conclusions Adding acarbose or metformin to insulin therapy could achieve improvements in glycemic control with similar reductions in HbA1Clevels and weight, when comparing with insulin treatment alone. Add-on acarbose to insulin therapy may exist more effectively on glucose fluctuation than that of add-on metformin, which may have important clinical implications in those patients with postprandial hyperglycemia, large blood glucose fluctuation, and intolerance to metformin.

Objective To explore the difference of efficacy and safety between denosumab and zoledronic acid in the treatment of patients with postmenopausal osteoporosis (PMOP), and to optimize the medication regimen for PMOP patients. Methods A total of 123 PMOP patients with high risk of fracture at the Second Affiliated Hospital of Naval Medical University from September 2021 to March 2024 were selected and randomly divided into two groups: the denosumab group (n=63) and the zoledronic acid group (n=60). Both groups underwent one-year treatment and follow-up, bone metabolism indexes, lumbar vertebrae, femoral neck, and total hip bone mineral density (BMD) were monitored, and any adverse reactions were documented. Results After treatment, the lumbar vertebrae and total hip BMD of patients in the denosumab group and the zoledronic acid group were significantly improved (P＜0.05); the femoral neck BMD of patients in the zoledronic acid group was also significantly improved (P＜0.05). The improvement of lumbar vertebrae BMD in the denosumab group was significantly better than that in the zoledronic acid group, while the improvement of femoral neck and total hip BMD in the zoledronic acid group was significantly better than that in the denosumab group (P＜0.05). Bone metabolism indicators were significantly improved in both groups (P＜0.05), and no significant liver and kidney dysfunction were observed. A total of 7 patients in the zoledronic acid group had mild adverse reactions and 5 patients in the denosumab group had mild adverse reactions. Conclusions Denosumab significantly increased lumbar vertebrae BMD and improved bone metabolism markers in PMOP patients, thus reducing risk of fracture and demonstrating good safety.