Objective To explore the expression of and its clinical significance of plasma omentin-1 in coronary heart disease in central obesity. Methods Plasma omentin-1 levels were measured by enzyme linked immunosorbent assay( ELISA)in 49 central obesity participants without coronary heart disease and 67 central obesity participants with coronary heart disease,as well as 56 normal healthy individuals as control group. In addition,glucose and lipid metabolism parameter and morphological characters were assessed. Finally multivariate logistic regression analysis was used to explore the risk fact for coronary heart disease in central obesity. Results The serum plasma omentin-1 level of central obesity participants without coronary heart disease group was (45. 63 ± 9. 66)μg/L,much higher than those of people in and central obesity participants with coronary group ((30. 67 ± 6. 78 )μg/L,P ﹤0. 01 ),while lower than control group(( 53. 12 ± 7. 97 )μg/L,P ﹤ 0. 01 ) . Multivariate logistic regression analysis revealed that,age was independent risk factor of coronary heart disease in central obesity(OR=1. 176,95%CI:1. 012-1. 330,P=0. 041),while plasma omentin-1 and high density lipoprotein cholesterol were independent protective factors(OR=0. 576,95%CI:0. 254-0. 898,P=0. 000;OR=0. 466,95%CI:0. 242 -0. 690,P =000). Conclusion Detection of plasma omentin-1 level may play an important role in early diagnosis and prevention of coronary heart disease in central obesity.

Objective To investigate the effect of Shensong Yangxin capsule on cardiac remodelling of myocardial infarction mouse model and the possible molecular mechanisms. Methods Adult male C57BL/6J mice were divided into sham operation group(n=10), model control group(n=20)and Shensong Yangxin group(n=20)according to random number table. Left anterior descending branch of coronary artery was ligated to establish myocardic infarction model in the model control group and Shensong Yangxin group. From the 2nd day after the surgery, Shensong Yangxin ( 400 mg . kg-1 ) was intragastrically administered, and the death rate of the mice was observed.Four weeks after the surgery, echocardiography was used to measure the cardiac function;myocardiac infarction area was detected by pathological staining;the expression levels of cardiac remodelling markers and extracellular matrix proteins were detected by RT-PCR. The possible molecular mechanisms were screened by Western blotting. Results As compared with the model control group, Shensong Yangxin significantly reduced the mortality after myocardial infarction in mice(P<0.05), as well as the myocardial infarct size(P<0.05).The mRNA expression levels of cardiac remodelling markers ANP, BNP, and β-MHC and the extracellular matrix proteins(collagenⅠ, collagen Ⅲ, CTGF, TGFβ) decreased significantly in the Shensong Yangxin group as compared with the model control group. Western blotting showed that Shensong Yangxin significantly decreased activation of smad3, and reduced expression level of smad4. Conclusion Shensong Yangxin attenuates cardiac remodelling after myocardial infarction and the mechanism may be related with blockage of smad signaling pathway.

Objective To observe and evaluate the effects of metformin and pioglitazone on blood glucose,insulin,glucagon,β-cell function and insulin resistance among patients with diabetes and metabolic syndrome,so as to discuss the role of pancreatic α cells in pathogenesis of type 2 diabetes mainly caused by insulin resistance and the change of α-cell function after treatment.Methods A total of 60 patients diagnosed with diabetes and metabolic syndrome were selected in Beijing Chaoyang District Diabetes Center from April 2012 to April 2013 and divided with random number table into metformin group (treated with metformin 0.5 g orally thrice a day for 1 year,n =30) and pioglitazone group (treated with pioglitazone 15 mg orally once a day for 1 year,n =30).30 normal healthy people who had physical examination at the Center during the same period were enrolled into the control group,matched in age and gender with the intervention groups.The general condition of the 3 groups,and blood levels of glucose,insulin,and glucagon,insulin sensitivity index (ISI)-Matsuda,homeostasis model assessment of insulin resistance (HOMA-IR),β-cell function index (HOMA-β),1-phase index,2-phase index,and insulin secretion sensitivity index (ISSI) at baseline in the 3 groups and after treatment in the metformin group and the pioglitazone group were measured and calculated.Results Compared with the control group before treatment,the intervention groups as a whole had significantly higher fasting glucagon level [(146.22 ±25.41) pmol/L vs.(21.31 ±7.85) pmol/L,P =0.002] and area under curve (AUC) of glucagon [(469.84 ±13.12) pmol/(L · h) vs.(100.94 ± 7.73) pmol/(L · h),P =0.006].Compared with the results before treatment,the metformin group exhibited significantly reduced fasting glucose [(6.46 ± 1.38) mmol/L vs.(7.54 ± 0.43) mmol/L,P=0.031],fasting insulin [(119.22 ± 69.01) pmol/L vs.(139.38 ±71.13) pmol/L,P =0.042],fasting glucagon [(91.69 ±22.11) pmol/L vs.(142.81 ±24.56) pmol/L,P=0.029],AUC of glucose [(25.19 ± 1.31) mmol/ (L · h) vs.(32.68 ± 1.12) mmol/ (L · h),P =0.043],AUC of insulin [(468.65 ±20.10) pmol/ (L· h) vs.(786.32±21.37) pmol/ (L· h),P=0.017],and AUC of glucagon [(280.60±8.26) pmol/ (L · h) vs.(487.14±14.31) pmol/ (L · h),P=0.032];while the pioglitazone group after treatment also showed significantly decreased fasting glucose [(6.58 ±2.21) mmol/L vs.(7.68±0.59) mmol/L,P=0.028],fastinginsulin [(107.92±17.81) pmol/L vs.(144.66±74.43) pmol/L,P =0.033],fasting glucagon [(76.07 ±20.57) pmol/L vs.(148.34 ±28.94) pmol/L,P=0.025],AUC of glucose [(25.58 ±1.22) mmol/(L·h) vs.(35.07 ±1.38) mmol/(L· h),P=0.038],AUC of insulin [(435.54±19.30) pmol/ (L· h) vs.(854.75 ±20.61) pmol/(L·h),P=0.013],andAUCofglucagon [(223.43 ±5.83) pmol/ (L·h) vs.(458.55 ±12.96) pmol/ (L·h),P =0.026].The before-after-treatment differences were significantly smaller in the metformin group than in the pioglitazone group in terms of fasting insulin [(20.16 ± 2.98) mmol/L vs.(36.74 ± 2.88) mmol/L,P =0.011],fasting glucagon [(51.12 ± 3.67) pmol/L vs.(72.27 ± 4.58) pmol/L,P =0.016],AUC of insulin [(317.67 ±13.45) pmol/(L · h) vs.(419.21 ±15.44) pmol/(L · h),P=0.031] and AUC of glucagon [(206.54±9.66) pmol/(L· h) vs.(235.12±10.29) pmol/(L· h),P=0.046].Conclusions Glucagon in patients with diabetes and metabolic syndrome is higher than that in normal individuals.Metformin and pioglitazone can decrease the level of glucagon in patients with metabolic syndrome and diabetes as well as improve the glucose control,β-cell function and insulin resistance,suggesting improving effect of these two drugs on α-cell function.Pioglitazone manifests a stronger effect than metformin does.

Objective To evaluate clinical features,insulin sensitivity,and serum adipocytokines levels in pregnant women with different glucose tolerance status and to investigate the possible serum predictive biomarkers of gestational diabetes mellitus (GDM).Methods We included 74 pregnant women with positive results of 50 g glucose challenge test (GCT),who received regular obstetrical follow-up in Peking Union Medical College Hospital from January 2009 to June 2012.A further 100 g oral glucose tolerance test was performed in 24-28 gestational weeks,based on which the 74 pregnant women were divided into GDM group (n =25),impaired glucose tolerance (IGT) group (n =25) and normal glucose tolerance (NGT) group (n =24).The clinical data were recorded in detail.Serum fibroblast growth factor (FGF)-19,FGF-21,visceral adiposespecific serine protease inhibitor (vaspin),leptin,insulin-like growth factor binding protein-1 (IGFBP-1),and adiponectin levels of the 3 groups were measured by enzyme-linked immunosorbent assay (ELISA) and compared.The associations of these adipocytokines with the patients' baseline data and metabolic indexes were analyzed.Results The blood glucose after GCT and glycosylated hemoglobin A1c in the GDM group were significantly higher than those in the NGT group [(9.21 ±0.75) mmol/L vs.(8.52 ±0.50) mmol/L,P ＜0.05;(5.39 ± 0.34) ％ vs.(5.18 ± 0.20) ％,P ＜ 0.05],but not significantly different from those in the IGT group [(9.14 ± 0.64) mmol/L,P ＞ 0.05;(5.28 ± 0.28) ％,P ＞ 0.05].Age,systolic blood pressure and diastolic blood pressure in the first trimester,pre-gestational body mass index (BMI),increment of BMI during pregnancy,serum total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and C-reactive protein levels in the three groups showed no significant differences (all P ＞0.05).From the NGT group to the IGT group to the GDM group,the area under curve of blood glucose (AUCBG) [(19.84±1.95),(23.20±1.51),(26.58±2.02) mmol/(L · h)] and AUC of insulin (AUCINS) [(1.84± 0.91) ×103,(1.85 ±1.15) ×103,(2.49 ±1.36) ×103 pmol/(L · h)] both gradually increased.Compared with the NGT group,the GDM group had significantly higher HOMA-IR [3.0 (1.5,5.2) vs.2.5 (1.5,3.4),P ＜0.05] significantly lower HOMA-β [230.5 (144.6,311.6) vs.235.6 (168.1,350.0),P ＜ 0.05].Among the GDM,the IGT,and the NGT groups,there were no significant differences in serum FGF-19 [(284.42±78.16),(268.17 ±72.97),(283.86 ±79.74) ng/L],FGF-21 [(798.16±273.57),(882.43 ±322.17),(842.75 ±343.01) ng/L],vaspin [(22.36 ±7.27),(23.53 ±7.90),(22.63±9.11) μag/L],leptin [(5.51 ± 1.44),(5.58 ± 1.58),(5.48 ± 1.47) μg/L],adiponectin [(798.85 ± 255.14),(863.44 ± 252.18),(828.36 ± 249.32) μg/L] and IGFBP-1 [(40.44 ± 16.41),(49.57±12.60),(43.80±16.58) μg/L] levels (all P＞0.05).Conclusions There are no significant differences of a variety of adipocytokines in pregnant women with different glucose tolerance status,and no effective serum predictors of GDM are found.The effect of adipocytokines in the pathogenesis of GDM remains to be further investigated.

Objective To explore the relationship between glycated albumin ( GA ) in 2 consecutive months and hemoglobin A1c ( HbA1c) in diabetes patients.Methods Totally 100 consecutive patients with main diagnosis of diabetes mellitus were enrolled retrospectively from April 2015 to January 2016 in outpatient clinic of endocrinology of Peking Union Medical College Hospital, who had undertaken GA tests every 4 weeks for 2 successive months and had HbA1c test in the second month.GA was measured with liquid enzymatic method. HbA1c was measured by ion-exchange high performance liquid chromatography.The relationship between HbA1c and GA for the 2 successive months was determined.Results A total of 85 patients were enrolled.The regres-sion equation between HbA1c (y) and average GA (j) for successive 2 months was y=3.187+0.218j (adjusted R2 =0.520, P=0.000), which showed a similar effect as the regression equation for HbA1c and the levels of GA tested for the 2 successive months (adjusted R2 =0.514, P=0.000), and both had more significant regressive effect than the regression equation for HbA1c and single measurement of GA (adjusted R2 =0.392, P=0.000). Conclusions The regressive effect between HbA1c and GA (or the average of GA) in successive 2 months is bet-ter than that with single measurement of GA, hence could better predict HbA1c in clinical practice.

Objective To compare the cortical activation characteristic in the healthy subjects and hemiplegia patients during execut-ing treadmill walking with visual feedback(TWVF). Methods From August to November,2021,eight stroke patients with right hemiplegia(patient group)and eight healthy subjects(healthy group)in Fifth Hospital of Xiamen were recruited.Both groups wore functional near-infrared spectroscopy(fNIRS)caps and executed TWVF,respectively.Experimental block design for walking modes in-cluded the preparation period(10 s)and task period(five cycles of"step 30 s-rest 30 s").The cortical activation(β values)were measured.The regions of interest(ROI)included the pre-motor cortex(PMC),supplementary motor area(SMA),primary motor cortex(M1),primary somatosensory cortex(S1)and sensorimotor cortex(SMC,M1+S1). Results No activation in bilateral M1,and some significant activation(P<0.05)in the left hemisphere SAM,PMC and S1,were found during walking in the healthy group.M1 was activated more in the unaffected(right)hemisphere than in the affected(left)hemisphere during walking in the patient group(P<0.05),and less PMC activation was found(P<0.05).M1 in bilateral hemispheres,SMA in the unaffected hemisphere and PMC in the affected hemi-sphere were activated more in the patient group than in the healthy group(P<0.05). Conclusion The locomotor network of SMC-PMC-SMA are activated more in the hemiplegic patients than in the healthy pepole during walking.M1 are almost not activated in the healthy people during walking,and compensa-torily activated in M1 of the unaffected side in the hemiplegic patients.

Glucocorticoids are widely used in clinical practice,and abnormal glucose metabolism due to the use of glucocorticoids is prevalent.There has been progress in studies evaluating post-glucocorticoid changes in blood glucose levels using continuous glucose monitoring.This paper reviews glycemic patterns and protocols for insulin treatment of abnormal glucose metabolism following the use of glucocorticoids as shown by continuous glucose monitoring.

Objective To explore the long-term outcome of postpartum glucose metabolism among patients with gestational hyperglycemia and its risk factors.Methods Patients with gestational hyperglycemia,diagnosed by 100 g oral glucose tolerance test (OGTT) during 24th to 28th gestation week between 2010 and 2012 and giving the childbirth in Peking Union Medical College Hospital,were included.The glucose metabolism outcomes were evaluated by 75 g OGTT.The risk factors influencing the glucose metabolism outcome and the glucose metabolism parameter changes between the pregnancy term and now were also analyzed.Results Forty patients with gestational hyperglycemia were included.The follow-up time was postpartum 5-8 years and (6.83±0.74) years on average.Among them,3 patients were diagnosed with type 2 diabetes and 9 patients were diagnosed with impaired glucose intolerance.The overall rate of abnormal glucose metabolism was 30 percent.The third-hour glucose of OGTT larger than 7.45 mmol/L and the area under the glucose curve (Glu AUC) during OGTT larger than 24.875 mmol×h/L were the risk factors for the abnormal glucose metabolism outcome,with the odds ratio of 5.769 (95％ confidence interval 1.064-31.270,P=0.042) and 12.5 (95％ confidence interval 2.226-70.187,P=0.004).Using the 2-hour glucose larger than 8.25 mmol/L and 3-hour glucose larger than 7.45 mmol/L in the OGTT of midtrimester to judge the glucose state in the follow-up visit can achieve the diagnostic efficacy with the sensitivity of 75％,specificity of 82％,positive prediction value of 64％ and negative prediction value of 88％.Comparing with now,the fasting glucose in the midtrimester was lower ([5.49±0.43] vs.[4.55±0.47] mmol/L,P＜0.001),the fasting insulin in the midtrimester was high-er (12.30 [6.35,16.55] vs.8.31 [6.79,12.00] μIU/ml,P=0.048),HOMA-β in the midtrimester was higher (202.67 [145.71,335.71] vs.85.41 [78.63,112.13],P＜0.001).Conclusion The third-hour glucose larger than 7.45 mmol/L and the glucose area under the curve larger than 24.88 mmol×h/L in the OGTT of midtrimester are the risk factors for the abnormal glucose state in the postpartum long-term follow-up.The combination of the second-hour and the third-hour glucoses in the 100 g OGTT of midtrimester can help to predict the postpartum long-term glucose state.

Objective To explore the relationship of MTNR1B DNA methylation with gestational diabetes and gestational glucose and lipid metabolism features.Methods 50 patients with gestational hyperglycemia,diagnosed by 100 g oral glucose tolerance test (OGTT) during mid-trimester were selected between 2009 and 2012.50 pregnant women with normal glucose tolkerance of matched age and body mass index were included in the control group.The blood samples during mid-trimester and the clinical parameters were collected.MTNR1B DNA methylation levels were measured.Results After adjusting age and body mass index,the CpG locus located at +64 bp away from the translation initiation site of MTNR1B was related with gestational diabetes (OR=0.859,95％ CI:0.772-0.955,P=0.005).DNA methylation level of several MTNR1B loci was also related with gestational glucose and lipid metabolism features.Conclusion MTNR1B DNA methylation is related with gestational diabetes and gestational glucose and lipid metabolism.

Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. Results Ultimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.