The clinical data of 239 inpatients with type 2 diabetes in Endocrinology Department of Henan Provincial People′s Hospital from January to February 2017 were collected. A total of 170 subjects were included in the final analysis. One diabetes-specific vertebral facture risk estimation called risk score for vertebral fracture was used to estimate the risk of vertebral fracture. Multivariate linear regression analysis was used to calculate the association of serum uric acid with risk of vertebral fracture. The mean age of subjects in final analysis was 56.5±26.4 years old, with the duration of diabetes 8.6±7.1 years and the vertebral fracture risk score 5.6±4.0. Additionally, there was a negative linear correlation between serum uric acid and vertebral fracture risk score in patients with type 2 diabetes( Ptrend=0.021) independent of age, gender, systolic blood pressure, HbA 1C, course of diabetes, obesity status, total cholesterol, and estimated glomerular filtration rate( P=0.033). Multivariate linear regression indicated that age, course of diabetes, blood pressure, total cholesterol, serum albumin, T score at femoral neck were related to the vertebral fracture risk score.

Objective:To investigate the correlation between serum calcium levels and severity of novel coronavirus pneumonia(COVID-19).Methods:The clinical data of 165 COVID-19 patients diagnosed from January to February 2020 were analyzed retrospectively. Combined with clinical classification, the differences of various indexes between the critically ill group and the control group were compared, and the influencing factors of disease severity were analyzed by multivariate logistic regression. According to the corrected serum total calcium levels, patients were divided into low calcium group and normal calcium group, and the related indexes of the 2 groups were compared for further analyzing the causes of hypocalcemia. Results:Compared with the control group, the age, diabetes, basic respiratory disease, and cardiovascular disease ratio, C-reactive protein(CRP), fasting blood glucose(FPG), interferon γ(IFN-γ), and interleukin 17(IL-17) levels increased while the lymphocyte percentage, serum albumin(ALB), corrected calcium levels, CD4 + T cells percentage, CD8 + T cell percentage decreased, the difference was statistically significant( P<0.05). There was no significant statistical difference in gender between the two groups, hypertension ratio, alanine aminotransferase(ALT), glomerular filtration rate(eGFR), CD4 +/CD8 + ratio and interleukin 4(IL-4) levels( P>0.05). The decrease of calcium level, age and eGFR were all risk factors for COVID-19 patients. Compared with the normal calcium group of COVID-19 patients, the level of ALB, CD4 + T cells percentage, CD8 + T cell percentage in low calcium group decreased and age, proportion of critically ill patients, diabetes, basic respiratory disease and cardiovascular disease ratio and CRP level all increased, the differences were statistically significant( P<0.05), and there was no statistical difference in the other biochemical indexes( P<0.05). Conclusion:There are obvious hypocalcemia and immune dysfunction in critically ill patients of COVID-19, and close monitoring of blood calcium levels may predict the severity of the disease more effectively

Objective:To investigate the association between time in target range and risk of vertebral fracture in patients with type 2 diabetes.Methods:The clinical data of 1 032 patients with type 2 diabetes who were hospitalized in endocrine department of Henan Provincial People′s Hospital from June 2017 to July 2021 were collected. Among which 632 patients were included into final analysis. The diabetes-specific risk score for vertebral fracture was used to assess the risk of vertebral fracture. Multivariate linear regression analysis was used to test the association between time in target range and risk score of vertebral fracture. Risk score≥9 was defined as increased risk of vertebral fracture. Multivariate logistic regression was used to estimate the association between time in target range and risk of vertebral fracture. Results:Among the included patients, mean age was(55.0±12.4) years and the percent of male was 72.5%. The mean course of diabetes was(9.4±8.0) years, and mean score of risk of vertebral fracture was 5.6±4.3. Time in target range was negatively correlated with risk score of vertebral fracture( P for trend <0.001), which was independent of potential confounders and continuous glucose monitoring parameters. The included patients were divided into four groups based on quartiles of time in target range. Multivariate logistic regression indicated that the risk of vertebral fracture in the first quartile of time in target range was 4.6 times higherthanthatinthe4thquartile, and the significance remained adjusted for potential confounders, s, CV, or meanamplitudeofglycemicexcursions(MAGE), respectively. Conclusion:Timein target rangewasnegativelycorrelatedwithriskscoreofvertebralfracturein patient with type 2 diabetes. Low time in range level was an independent risk factor for increased risk of vertebral fracture.

Objective:To systematically evaluate the teaching effect of problem-based learning (PBL) plus case-based learning (CBL) versus lecture-based learning (LBL) in surgical internships in Chinese medical students.Methods:We searched PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and WanFang Data for randomized controlled studies evaluating PBL+CBL versus LBL in surgical internships in Chinese medical students. The retrieval time was from database establishment to June 2019. Data analysis was performed using RevMan 5.2 software.Results:Seventeen randomized controlled trials were included, involving a total of 1161 students, including 581 in the PBL+CBL group and 580 in the LBL group. Meta-analysis results showed that the PBL+CBL group had significantly higher scores of theory examination [mean difference ( MD)=6.15, 95%CI=4.14-8.15, P<0.001], skill examination ( MD=7.67, 95%CI=3.66-11.69, P<0.001), and case analysis ( MD=6.06, 95%CI=2.89-9.23, P=0.000 2) compared with the control group. The PBL+CBL group had a significantly higher percentage of satisfaction with the teaching results than the LBL group [odds ratio( OR)=2.98, 95%CI=1.88-4.73, P<0.001]. Conclusion:PBL+CBL is superior to LBL in medical students' surgical internships, which needs verification by more high-quality studies due to limitations in the number and quality of the included studies.

Objective:To investigate the association of time in range(TIR) with the severity of coronary artery disease and acute coronary syndrome in patients with type 2 diabetes mellitus.Methods:A total of 216 patients with type 2 diabetes mellitus and coronary heart disease were recruited and undergone anthropometric and biochemical measurements, continuous glucose monitoring, and calculation of SYNTAX score. TIR was defined as the percentage of time within the glucose range of 3.9-10.0 mmol/L during 24 h. Spearman correlation analysis and multivariate linear regression analysis were used to evaluate the correlation factors of SYNTAX score. Multivariate logistic regression analysis was used to analyze the association of TIR with the severity of coronary artery disease and acute coronary syndrome. Results:Compared with patients with mild coronary artery disease, TIR in patients with moderate to severe coronary artery disease was lower[(69.4±17.3)% vs (60.8±17.8)%, t=3.0, P=0.003], and HbA 1C of patients with moderate to severe coronary artery disease was higher [(9.6±1.7)% vs (8.8±1.6)%, t=3.3, P=0.001]. SYNTAX score was negatively correlated with TIR ( r=-0.251, P<0.01) and positively correlated with HbA 1C ( r=0.249, P<0.01). Moreover, compared with HbA 1C (standardized coefficients=0.181, P=0.007), TIR (standardized coefficients=-0.192, P=0.004) had a greater influence on SYNTAX score. Multivariate linear regression analysis showed that TIR, HbA 1C, duration of diabetes and smoking were independently correlated with SYNTAX score. Multivariate logistic regression analysis revealed that compared with TIR Q1, Q3 and Q4 were independent protective factors for moderate to severe coronary artery disease (respectively, OR=0.61 and 0.59, 95% CI 0.39-0.96 and 0.38-0.94, P=0.014 and 0.009) and acute coronary syndrome (respectively, OR=0.51 and 0.39, 95% CI 0.32-0.95 and 0.26-0.75, P=0.022 and 0.008). Conclusion:TIR was significantly and independently correlated with the severity of coronary artery disease and acute coronary syndrome in type 2 diabetes mellitus after controlling confounding factors. When TIR level was decreased, the severity of coronary artery disease was aggravated, and SYNTAX score and the risk of acute coronary syndrome was increased.

Diabetic kidney disease is a severe microvascular complication of diabetes characterized by complex etiology, diverse mechanisms, long course, and poor prognosis, posing a significant threat to patients′ quality of life. In recent years, research on gut microbiota has progressed deeper, and the concept of the gut-kidney axis emerges, introducing novel therapeutic concepts. This article provides an overview of the role of gut microbiota in the development of diabetic kidney disease and explores potential therapeutic strategies involving gut microbiota for the treatment of this condition.

Objective:To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes.Methods:This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis.Results:Pearson correlation analysis showed that LSM was negatively correlated with TIR( r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR; r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM( β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM( β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD( OR=1.96, 95% CI 1.07-3.62, P=0.027), advanced liver fibrosis( OR=3.82, 95% CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD( OR=1.22, 95% CI 1.04-1.43, P=0.005) and advanced liver fibrosis( OR=1.26, 95% CI 1.03-1.54, P=0.025). Conclusions:TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.