The changes in hypothalamic-pituitary function in older people include the effects of aging per se on hypothalamic-pituitary physiology,such as age-related declines in GH-IFG-1 system and increased activity in CRH-ACTH axis,and the hormone hyposecretion due to anterior pituitary diseases in elderly,including fibrosis and vascular alterations.In considering changes in hypothalamic-pituitary function in older people,it is important to distinguish between what is age-related and what is disease-related.Symptoms associated with hypopituitarism are nonspecific and may be often attributed to normal aging and can be challenging in clinical practice.Furthermore,the benefits and safety of selective pituitary hormonal replacement,including growth hormone replacement,remain controversial in the elderly.The evidence for age-related changes in GH-IGF-1 system and CRH-ACTH axis and their clinical consequences are reviewed.The characteristics in the clinical approach to disease-related hypopituitarism in older person are also briefly discussed.

Insulin resistance(IR) is a independent risk factor of ichemic angiopathy .The abnormal state of thrombosis and fibrinolysis is a critical pathology component of IR,and play a vital role in initiating and developing cardiovasculer disease. Under IR state, the,inhancement of plasminogen-activator inhibitior-1(PAI-1)synthesis by adipose tissue and the reduced generation of nitric oxide with endothelial dysfunction contribute to the hypo-fibrinolytic/pro-thrombotic state and promote atherosclerotic. Accompanied with IR developing, when B cell function can't keep normal glycemia, the advanced glycosylation end products(AGEs) are increased as a result of hyperglycemia. AGEs can aggravate endothelial injury and accelerate the course of atherosclerotic. Fully comprehending the pathogenesis of thrombosis and fibrinolysis in IR and taking therapy for the pathology have clinical significance.

Sixty diabetic patients and twenty normal controls were studied. The results showed that: 1) Counter-immuno-electrophoresis is a sensitive and simple test suitable for the detection and monitoring of diabetic microproteinuria; 2) The proteinuria in diabetic nephropathy is glomerular in origin which is supported by the finding of a marked increase in urinary albumin excretion and a normal level of urinary ?2-microglobulin; 3) The serum ?2-microglobulin appears to be a more sensitive index than serum creatinine and creatinine clearance rate for the detection of impairment of renal function in diabetic patients; 4) Diabetic nephropathy is related to glycemic control and duration of diabetes mellitus.

Ketosis-prone diabetes mellitus(KPDM) may be a subtype of type 2 diabetes,characterized by fulminant onset,with diabetic ketoacidosis and usually obesity and over-weight,as well as a positive family history of diabetes,but lacking markers of autoimmunity observed in classic type 1 diabetes.Recovery of glucose homeostasis,accompanied by recovery of ?-cell function,follows intensive glycemic regulation by insulin.Because of the mixed features of type 1 and type 2 diabetes,there is no completely agreement on diagnostic criteria and classification according to clinic presentation,metabolic and immunologic features of the novel atypical diabetes.Additional pathophysiological and genetic insight is therefore needed to provide a better understanding of the mechanisms of partially reversible insulin secretary defect in such syndrome,which is critical for its clinical classification and the development of appropriate treatment strategies.

Protein kinase C(PKC) is a serine/threonine kinase groups including a series of isoenzyme.Hyperglycemia and elevated free fatty acid can affect signal transduction pathway function,in particular activation of diacylglycerol (DG) and PKC,which occurs in the diabetic state. Activation of PKC lead to insulin resistance and diabetic vascular complications. PKC ? isoform selective inhibitor(LY 333531) and vitamin E have shown potential effect as therapies for diabetic vascular complication.

Objective To evaluate the relationship of the levels of serum oxide and antioxide with endothelium-dependent vasodilatation(EDV) in obese subjects and to explore the effect of oxidative stress on endothelial dysfunction in obese subjects. Methods 20 euglycemic obese males (Ob) and 13 age- matched normal controls (NC) underwent euglycemic hyperinsulinemia clamp study to evaluate the peripheral glucose disposal rate (GDR) in steady-state and brachial artery ultrasound studies to assess the endothelium-dependent vasodilatation (EDV). The serum levels of ROS, MDA, GSH-PX, GSH and free fatty acids (FFAs) were measured. Results The serum ROS, MDA and FFA concentrations were significantly higher in Ob group than in the controls (P

Objective To investigate the associations between microalbuminuria and early atherosclerosis in type 2 diabetes.Methods We measured the combined intima-media thickness (IMT) of the common carotid arteries and the inner diameter (ID) of tibia artery with high resolution ultrasound in 30 type 2 diabetic patients,and compared with 13 age-matched non-diabetics as control.The diabetic patients were subgrouped into DM-A subjects whose urinary albumin excretion were normal,and DM-B subjects who were with microalbuminuria,and DM-C subjects who with macroalbuminuria.Results The results showed that the IMT values were greater in diabetic patients than in control subjects (0.65 ?0.12 mm vs 0.48?0.06mm, P

Objective To understand the variation of the motality and death causes for diabetic inpatients in West China Hospital(WCH) during 1996～2004. Methods First,the amount of diabetic inpatients(14670) and died persons (9597)were got each year by computer search system of our hospital from 1996 to 2004,and the case code of died diabetic subjects (842)were obtained.Then,those medical records were investigated and reviewed in details to get useful information.The motality,death causes and its constituent ratio of dead diabetic inpatients were analysed. Data input and analysis were conducted using the tool Epidate3.0,packages SPSS13 and SAS8.0. Results There were totally 14760 inpatients and 842 deaths who were suffered from DM during 1996-2004.The mortality rate was 5.74% and the standardized mortality rate was 5.37%.Tumor was the first cause of deaths (22.3%),followed by infection(15%),fatal cardiovascular events(14.4%),cerebrovascular events(12.3%).Diabetic nephropathy(DN)(6.3%) took the 6th place just after COPD(8%).There were 9269 deaths in the hospital in total(≥15 years old) during 1996-2004 while DM patients contributed 9.08% to them.The proportion of diabetic patients among the total deaths kept increasing every year(χ2=71.9070,P<0.01). Conclusions The mortality proportion of diabetic inpatients among the total deaths in West China Hospital from 1996 to 2004 is increasing every year.It needs to pay more attention to the main death cause of tumor in diabetic patients

Observations were carried out in 10 moderately well controlled diabetic patients on their usual therapeutic regimens from 10Pm to 10Am on two days.On the control day,samples were obtained without intervention.On another day,nocturnal hypoglycemia was induced.Nocturnal hypoglycemia did not appear to cause clinically important fasting and postprandial hyperglycemia in diabetic patients.It is sug- gested that the morning hyperglycemia is not caused by Somogyi effect but dawn phenomenom.