Objective To investigate the clinical value of GFR, microalbuminuria (mAlb), serum β2-microglobulin (MG) and cystatin C (CysC) for the evaluation of renal function in patients with DN.Methods A total of 150 patients with type 2 DM diagnosed by WHO standard (1999) from December 2012 to December 2015 were retrospectively analyzed.Thirty-three kidney transplantation donors during the same time were chosen as the control group.The urine mAlb, Cr, albumin/Cr ratio(ACR) and SCr, serum β2-MG, CysC, urea, uric acid(UA), fasting blood glucose (FBG), hemoglobin A lc (HbA1c) and C-reactive protein (CRP) were measured.99Tcm-DTPA renal dynamic imaging was performed.The Gates method was used to calculate GFR, and the modification of diet in renal disease (MDRD) method was used to calculate the estimated GFR (eGFR).The relative equation between GFR and eGFR was studied.The clinical stages of renal function in type 2 DM patients were evaluated by Mogenesen standard method.Two-sample t test was used for data analysis.ROC curve analysis was performed to study the diagnostic value of GFR in DN.Results The patients were divided into merely type 2 DM group, early stage DN (Ⅰ, Ⅱ, Ⅲ), and clinical DN(Ⅳ) groups by Mogenesen standard method.GFR and eGFR in the DNⅠstage were higher than those of the merely type 2 DM group (t values:-7.502,-3.629, both P<0.01), and GFR and eGFR decreased with the increased stage of DN.However, serum UA, CRP, FBG and HbA1c, SCr, urea, β2-MG, CysC, mAlb and ACR increased when the stage of DN was higher.GFR and eGFR showed a linear correlation, with the regression equation of y=0.957x+6.823.AUC of ROC in patients with DN Ⅰ was 0.989.With the cutoff value of 125.09 ml/min, the sensitivity and specificity was 96.2%(25/26) and 98.4%(122/124) respectively in diagnosis of DNⅠ.Between high UA and normal UA groups, FBG and HbA1c were not significantly different (t values:-1.010,-1.034, both P>0.05), but the renal function indicators were different (t values:-5.090-2.209, all P<0.01).Compared with the normal CRP group, the FBG, HbA1c and renal function indicators were statistically different in high CRP group (t values:-6.114-7.386, all P<0.01).Conclusions GFR and eGFR show a linear relationship in type 2 DM.GFR is a sensitive, specific diagnostic index in DN Ⅰ period.β2-MG, CysC, mAlb and ACR are conducive to the early diagnosis of DN.High UA is an independent risk factor for the onset of DN, and high CRP is an inflammatory damage factor in DN.

Objective To determine the expression and distribution of Disabled-2(Dab2) in normal human adrenal glands, and further to study the expression of Dab2 in tissues of different adrenocortical adenomas, and to elucidate whether Dab2 can be a specific molecular marker in the pathology of primary aldosteronism. Methods Real-time PCR and immunohistochemical staining were used to detect Dab2 expression in 10 aldosterone-producing adenoma (APA) samples, 8 cortisol-producing adenoma ( CPA) samples, 8 non-functioning adenoma ( NFA) samples and 6 normal adrenal samples. Results Immunohistochemical staining showed that Dab2 was significantly highly expressed in zona glomerulosa of normal human adrenal glands. Sporadical cluster of ZG cells with moderate Dab2 staining were demonstrated in APAs. In all CPA and NFA tumors, weak dab2 staining was detected. According to the results of real-time PCR, Dab2 mRNA expression was increased significantly in APAs compared with normal adrenal glands. There was no significant difference between normal adrenal glands, CPAs, and NFAs in regard to Dab2 mRNA expression. Compared to nontumor portions, APAs also showed higher Dab2 mRNA expression in the tumor( P<0. 05). Conclusion Dab2 was predominantly localized in zona glomerulosa in normal adrenal gland. Increased Dab2 mRNA expression was detected in APAs compared with normal adrenal glands. Whereas, Dab2 protein expression was just moderate increased in APAs. Weather Dab2 can be a specific molecular marker in the pathology of primary aldosteronism has to be further studied.

Objective: To explore the changes of pulmonary function in type 2 diabetes and its related factors.Methods: The pulmonary functions of 72 patients with type 2 diabetes and 22 healthy objects were measured,and the related factors,such as duration of DM,HbA1c,BMI,were analysed with linear regression analysis.Ninteen of them underwent a 12-week-long intensive insulin therapy and pulmonary function tests before and after the treatment.Results: Vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),total lung capacity(TLC) and carbon monoxide diffusion in the lung(DLco) were significantly decreased in the diabetes patients.Correlation analysis revealed that DLco was negatively correlated with the duration of DM.which was shown by linear regression analysis to be the only significant predictor.After a 12-week-long intensive insulin therapy,DLco and DLco/VA decreased significantly.Conclusion:Patients with type 2 diabetes have abnormal pulmonary ventilatory function and impaired pulmonary diffusive function,and the latter is related to the time of hyperglycemia,and can not ameliorated by short-term glycemic control.

Objective To investigate the clinical and pathological characteristics of normotensive pheochromocytomas ( NP) . Methods This retrospective study included 97 patients with a pathological diagnosis of pheochromocytoma at the Drum Tower Hospital Affiliated to Nanjing University Medical School during January 2004 to December 2013. All available clinical, biochemical, and radiological records were reviewed in these patients who were then categorized into hypertensive pheochromocytomas (HP) (n=64) and NP (n=33) groups. 97 cases of Adrenal Gland Scale Score of pheochromocytoma were examined, including tissue microscopic pathology assessment, ki67 and phenylethanolamine-N-methyltransferase ( PNMT ) immunohistochemistry and catecholamine type. Biochemical examinations of 95 subjects with primary hypertension ( PH) were recorded for comparative study. Results The patients with NP showed lower proportion of clinical triad than HP, inapparent metabolic disorders, and lower urinary catecholamine levels than HP, but showed higher results than primary hypertension. The weight of tumor was positively correlated with 24 hour urinary norepinephrine level in patients with HP(Y=1. 376+0. 653X,R2=0. 118, P=0. 028), but not in patients with NP;and the size or diameter of the tumor was negatively correlated with PNMT immunohistochemistry in patients with NP(Y=0. 940-0. 356X, R2=0. 494, P=0. 005), but not in patients with HP, indicating that NP may be misdiagnosed clinically. Conclusion Patients with NP have distinct clinical, biochemical, and pathological phenotypes; the phenotypic changes are closely related with the expression levels of catecholamine pathway products during the occurrence and development of the tumors.

A group of 19 referred hypertensive patients were diagnosed to have primary aldosteronism(PA) with inconclusive computed tomography scan results.Adrenal vein sarmpling (AVS) was performed in all patients.AVS was successful in 16 cases but failed in 3 cases.According to the results of AVS and postoperative pathology,8 cases were diagnosed as aldosterone-producing adenoma (APA) and unilateral adrenal hyperplasia (UAH),and the other 8 cases were diagnosed as idiopathic hyperaldosteronism (IHA).In conclusion,AVS is one of the most crucial methods in typing diagnosis of PA.

Objective To determine the status of glycemic control in type 2 diabetic patients in Jiangsu province. Methods Survey was conducted among outpatients with type 2 diabetes mellitus from 56 diabetes centers including 23 tertiary hospitals, 18 secondary hospitals and 15 primary hospitals, covering 13 cities in Jiangsu province. Data were obtained by patient interview and by reviewing medical records of the most recent laboratory assessment and clinical examinations. Blood samples were collected during patient′s visits for assessment of HbA1C. Results The mean HbA1Cof 2 966 patients was 7.18%±1.58%. Mean age of patients was(56.4±11.2) years, mean duration of diabetes was(6.3±5.7) years, and mean body mass index was(24.5±3.3) kg/m2. The proportion of good control was 40.2% defined as HbA1C＜6.5%. 42.2% of the patients in the tertiary hospitals, 36.5% of the cases in the secondary hospitals, and 36.2% of cases in the primary hospitals achieved that goal with HbA1C＜6.5%, while age, body mass index, and duration of diabetes revealed no difference among these 3 groups of patients. Conclusions The status of glycemic control in Jiangsu province has been improved as compared with the result from national survey performed 3 years ago. Patients from tertiary hospitals are better controlled than those from secondary and primary hospitals. Structural interventions to improve diabetes care in secondary and primary hospitals are needed.

Objective:To investigate the association between polycystic ovary syndrome (PCOS) and cardiovascular risk factors and evaluate 10-year risk of cardiovascular disease (CVD) in women with PCOS.Methods:239 PCOS patients (PCOS group) and 134 age-matched non-PCOS participants (control) were enrolled in this retrospective study.The general data was collected and biochemical test, glucose tolerance, sex hormones were detected.The Framingham score (FRS) for all women was evaluated according to age, systolic blood pressure (SBP), serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and history of smoking.The clinical features, laboratory parameters and FRS of PCOS patients and non-PCOS controls were compared.The correlation between FRS and metabolic indicators and sex hormones was analyzed.Results:①Compared with those of the control group, SBP and diastolic blood pressure (DBP) significantly increased, the glucose and lipid metabolism was moredisordered, and the androgen level was higher in PCOS group (P＜0.05).② The FRS of the PCOS group was higher than that of the control women (P＜0.01).③ FRS were positively correlated with BP, FPG, PBG, FIns, PIns, HOMA-IR, TC, TG, LDL-C.FRS was negatively correlated with HDL-C and SHBG (P＜0.05).Conclusions:PCOS is correlated with major cardiovascular risk factors, such as hypertension, hyperglycemia, and hyperlipidemia.PCOS show a higher risk of 10-year CVD events than individuals without PCOS.The phenomenonis mainly related to blood pressure and glycolipid metabolism but not androgen.

Objective To investigate the clinical features of non- functioning pancreatic neuroendocrine tumors and to summarize experiences in the diagnosis and treatment. Methods The clinical pathology and follow-up data of 20 patients with non-functioning pancreatic neuroendocrine tumors treated in Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, from January 2008 to February 2018 were retrospectively analyzed. Results Among the 20 patients, 9 patients (9/20) were asymptomatic, and the tumor was found unexpectedly by physical examination. Eleven patients (11/20) with symptoms were admitted to the hospital due to non-specific gastrointestinal symptoms or compression symptoms caused by tumor space occupying. None of the patients had endocrine disorders. There were nineteen patients who received surgical treatment. According to the grading system, there were 7 patients (7/19) with G1, and 12 patients (12/19) with G2 . Among the 14 patients with diameter of tumor greater than 2 cm, there are 4 patients (4/14) with lymph node metastasis, and 4 patients (4/14) with liver metastasis. Five patients with diameter of tumor less than or equal to 2 cm had no distant metastasis. Conclusions NF-pNETs is often with nonspecific symptoms. Imaging examination is an important diagnostic method. Operation is the primary therapy for NF-pNETs. Because most of the small NF-pNETs with no symptoms are benign and grow slowly, and the metastatic rate is very low. It is important to weigh the pros and cons of surgical treatment for these patients.

Objective To determine the association of subclinical hypothyroidism (SCH) with body composition (measured by body impedance analysis) and insulin resistance (IR) in overweight/obese patients with polycystic ovary syndrome (PCOS).Methods A retrospective analysis was conducted of the clinical records of 109 overweight or obese [body mass index (BMI) ≥ 24 kg/m2] PCOS patients who visited the Department of Endocrinology and Fertility Center of Nanjing Drum Tower Hospital between April 2013 and April 2016 for menstrual disorder or infertility and were referred to receive weight management.24 of the patients had SCH,and 85 had euthyroid (EU).We determined the body composition of the patients with Biospace Inbody 720 body composition analyzer,measured the patients' serum lipid profiles,conducted in each patient the 75 g oral glucose tolerance test and the insulin release test,and calculated the homeostasis model assessment of insulin resistance (HO-MA-IR) indices.Results Patients with SCH and autoimmune thyroiditis (AIT) accounted for 22.02％ and 24.36％ of the total.The obesity level [(145.19±13.75)％ vs.(153.31±18.15)％,t=-2.032,P=0.045],VFA [(132.48±20.85) cm2vs.(147.35±24.26) cm2,t=-2.730,P=0.007],body fat (BF) [(31.91±5.88) kgvs.(35.43±6.89) kg,t=-2.274,P=0.025],body fat percentage (BFP) [(40.92±3.701)％ vs.(43.07±4.26)％,t=-2.241,P=0.027],body mass index (BMI) [(30.49±2.88) kg/m2 vs.(32.19±3.81) kg/m2,t=-2.026,P=0.045] and waist circumference (WC) [(98.34±7.13) cm vs.(102.86±8.74) cm,t=-2.324,P=0.022] of SCH group were significantly lower than those of euthyroid,with significant statistical difference.The levels of serum thyroid hormone (TSH) in patients with EU were positively correlated with the degree of obesity,the BF,the BFP,the BMI and the hip circumference (P=0.019,0.042,0.005,0.019,0.039),but not with the VFA (t=1.797,P=0.076).There were no statistically significant differences (P＞ 0.05) between patients with SCH and those with EU in their HOMA-IR indices,insulin levels,blood glucose,blood lipid,and ratio of IR (defined as HOMA-IR ≥2.69).Conclusions Obesity related body composition parameters were lower in PCOS patients with SCH than in those with EU.However,there was no significant difference between the two groups in blood lipid level and the ratio of IR.TSH levels in the EU group were correlated with the BMI and the BFP,but not with the VFA.A larger sample is needed to identify how and why thyroid hormones may affect the body composition and glycolipid metabolism of females with PCOS.

To explore the clinical characteristics, diagnosis, and management of pancreatic glucagonoma, a retrospective analysis of the clinical data and diagnostic algorithm of a patient with pancreatic glucagonoma was conducted, along with literature review. Pancreatic glucagonoma is a rare neuroendocrine tumor that originates from the pancreatic alpha cells. The main manifestations of glucagonoma syndrome(GS) include necrolytic migratory erythema, diabetes, anemia, and other systemic involvement. Early diagnosis of GS is challenging and crucial. Early identification and recognition of skin lesions contribute to timely diagnosis and treatment of the disease. Surgical resection is an effective treatment modality for glucagonoma.