Objective To observe the improvement of weight rebound in obese type 2 diabetes mellitus patients who underwent metabolic surgery after low-carbohydrate diet intervention.Methods 38 patients with obese type 2 diabetes mellitus who had underwent metabolic surgery in Changhai Hospital from Jan.2010 to Nov.2015,were randomly divided into two groups and intervened by low carbohydrate (LC) diet or diabetes mellitus (DM) diet.The blood glucose and body weight of the two groups were compared and analyzed.Results There was no statistical difference in fasting blood glucose,HbA1c,fasting C-peptide,body weight,waistline and BMI value(t=0.34,S=1.00-32.5,P＞0.05)in diabetes mellitus diet intervention group;while there was significant statistical difference in fasting blood glucose,body weight,waistline and BMI (t=2.38,S=17-24.5,P＜0.05)in low-carbo hydrate diet intervention group.There was significant differences in body weight difference (Z=2.31,P＜0.05),BMI difference(Z=2.36,P＜0.05),and weight rebound rate(P＜0.05) between the two groups,with the low carbohydrate diet intervention group displaying advantages.Conclusions Low carbohydrate diet intervention can improve fasting blood glucose,obesity indexes in obese type 2 diabetes mellitus patients who underwent metabolic surgery.Compared with diabetes mellitus diet intervention,low carbohydrate diet intervention can more greatly improve weight,weight rebound rate,rebound scale and have more advantages for maintaining the operation effects.

Objective Glucagon-like peptide-1 (GLP-1) has been reported to be effective in the treatment of nonalcoholic fatty liver disease (NAFLD). However, the molecular mechanism of GLP-1 on NAFLD is remained unclear. The present study was to detect whether the effect of GLP-1 on triglyceride (TG) content in hepatocytes is dependent on Foxos. Methods HepG2 cells were treated with palmitic/oleic acid for 24 h. The knockdown of Foxo1, Foxo3 was conducted through small interfering RNA (siRNA). Real time PCT (RT-PCR) was used to detect the changes of the SREBP1c and Acox2 genes in HepG2 cells after Foxo1/3 knockdown. Results As expected, palmitic/oleic acid increased TG concentration in HepG2 cells [(12.65 ± 1.32) μg/mg vs. (4.32 ± 0.54) μg/mg, P<0.05]. Addition of GLP-1 dose (10, 50, 100nmol/L) dependently lowered the TG content and reached plateau at 100 nmol/L of GLP-1 [TG(8.38±1.47) μg/mg]. The GLP-1 effect on TG remained after knocking down either Foxo1 [(9.09±1.34)μg/mg] or Foxo3 [(8.90± 1.60) μg/mg] alone, but not when knocking down Foxo1 and Foxo3 (Foxo1/3) together [(14.66±1.77)μg/mg]. Moreover, knocking down Foxo1/3 also abolished GLP-1 effect on SREBP1c and Acox2 expression. Conclusion GLP-1 can inhibit the synthesis of TG in hepatocytes depending on Foxo1 and Foxo3. Further studies are needed to explore the specific mechanisms.

Objective To explore the correlation between thyroid nodules and uric acid levels and to find their gender differences.Methods A total of 68 056 subjects in a regional medical physical examination center of Shanxi Province from January 2013 to June 2015 were enrolled in this study.All the participants′ general information and parameters were recorded.Thyroid nodules were detected by color Doppler ultrasonography.Results The total prevalence of thyroid nodule was 35.5%, 30.7% in males and 40.0% in females.The prevalence of single nodule was 50.1%, and multiple 49.9%.Compared with no nodule group, thyroid nodule group tended to be older, with higher BMI, and with a worse metabolic status(all P<0.01).The uric acid levels were lower[(352.37±78.14 vs 357.70±77.51) μmol/L, P<0.01] in thyroid nodule group in male and higher[(260.22±61.91 vs 253.91±59.18) μmol/L, P<0.01] in female.Conclusion Thyroid nodules may be associated with metabolism and inflammation.In males, hyperuricemia group had lower, while in females, hyperuricemia ones were with a higher prevalence of thyroid nodules.

[Summary] The incidence of obesity and obesity‐related diseases (such as T2DM) increases year by year in the world. Metabolic surgery has increasingly been applied to patients with severe obesity. Studies have indicated that metabolic surgery is effective in obesity and obesity‐related diseases. Since patients undergoing metabolic surgery are obese or severely obese ,whose physiological and pathological changes are different with those of non‐obese patients ,a comprehensive assessment and management during perioperative period and after the operation were needed. This article mainly expounds preoperative evaluation and preparation ,management of surgery process and postoperative nutrition and endocrine management.

Adipocyte fatty acid-binding protein ( FABP4 ) is abundantly expressed in adipocytes and macrophages, and the physiologic function of this lipid chaperone is involved in the intracellular trafficking and targeting of fatty acids inside cell. Studies have shown that FABP4 plays a significant role in cholesterol metabolism. FABP4 can affect some key gene expression for cholesterol metabolism, thus regulate the metabolism, storage, and trafficking of cholesterol. As the development of FABP4 inhibitors, drugs targeting FABP4 are possible and can lead to a novel therapeutic strategy to prevent and treat obesity, type 2 diabetes, hypercholesterolemia, and atherosclerosis.

Objective The cancer risk of patients with diabetes mellitus who are treated by metformin declines remarkably in comparison to patients receiving other drug therapies.The article was to investigate the relationship between antineopastic activity and fatty acid synthase (FASN) of metformin in human hepatocellular carcinoma cell(HCC) line HepG2. Methods HepG2 cells were treated with various concentrations of metformin( 0, 1, 5, 10, 15 mmol/L) for 24, 48 and 72 h respectively and cell growth was assessed by CCK-8 assay.Positive control(paclitaxel 10μg/mL) and negative control(metformin 0mmol/L) were set up simultaneously.After being treated with doses of metformin(0, 5, 10,15mmol/L) for 72h, protein expression levels of AMPKα、P-AMPKα、FASN、P-mTOR and P-Akt were measured by western blotting analysis and FASN mRNA expression levels were measured by RT-PCR. Results Being treated with vari-ous doses of metformin(1, 5, 10, 15 mmol/L) for 24, 48 and 72 h, the growth of HepG2 cells were inhibited by metformin in dose-dependent and time-dependent manner( P<0.05) .The growth inhibition rate approached 50%after being treated with metformin for 72 h, and the growth inhibition rate were all greater than 50%after being treated with 15 mmol/L of metformin.At 72 h after the treatment of various do-ses of metformin(0, 5, 10, 15 mmol/L) on HepG2 cells, the protein expression of P-AMPK increased with the rise of metformin concentra-tion, while the protein expressions of P-mTOR and FASN decreased as the metformin concentration increased.Compared with negative control group, the protein expression levels of P-AMPKα, P-mTOR and FASN all changed significantly in 10 mmol/L group and 15 mmol/L group(P<0.05).However, there was no significant difference as to the protein expression levels of P-Akt in various metformin concen-trations( P>0.05) .FASN mRNA expression levels decreased significantly in all metformin-treated groups( P<0.05) . Conclusion Met-formin actitiviates AMPK, inhibits mTOR and downregulates FASN, which are implicated in its antineopastic activity on HCC.Although metformin inhibits mTOR activation, it is not involved in Akt upregulation through a negative loop.

Objective :To explore the correlation between serum gamma-glutamyl transpeptidase (GGT ) level and carotid atheromatous plaque in patients with type 2 diabetes mellitus (T2DM ) accompanied by nonalcoholic fatty liver disease (NAFLD) . Methods :The clinical data of 230 patients with T2DM admitted during January 2010 and June 2015 were retrospectively analyzed .Patients were divided into three groups :simple T2DM with normal GGT level(GGT < 50 U /L)group (Group A ,n= 100) ,T2DM accompanied by NAFLD with normal GGT level(GGT < 50 U /L)Group (Group B ,n= 100) ,and T2DM accompanied by NAFLD with abnormal GGT level (GGT ≥ 50 U /L) Group (Group C ,n= 30) .Each patient's data such as age ,sex ,course of disease ,current smoking ,carotid plaque ,systolic blood pressure (SBP) ,body mass index (BMI) ,waist circumference (WC) ,fasting plasma glucose (FPG) ,two hours postprandial glucose (2 h PG) ,glycosylated hemoglobin A1c (HbA1c) ,total cholesterol (TC) ,triglyceride (TG) ,low density lipoprotein cholesterol (LDL-C) ,high density lipoprotein cholesterol (HDL-C ) ,gamma-glutamyl transpeptidase (GGT ) , alanine aminotransferase (ALT ) , fasting serum c-peptide (FCP) ,and high-sensitivity c-reactive protein (hsCRP) ,were collected and evaluated .Results :The incidence rate of carotid plaque in Group C(83 .3% ,25/30)was significantly higher than that in Group B(64% ,64/100)and Group A (60% ,60/100) , however ,there was no significant difference . There were statistically significant differences regarding BMI , WC , FPG , HbA1c ,LDL-C ,hsCRP between Group A and Group B and Group C (P< 0 .017) ,however ,there was significant difference regarding HDL-C between Group A and Group B (P < 0 .017) ,there was significant difference regarding SBP ,2 h PG ,TG between Group A and Group C (P< 0 .017) .The BMI ,FPG ,2 h PG ,HbA1c ,GGT ,ALT ,TG in Group B was significantly higher than those in Group C (P < 0 .017) .There was no statistically significant difference regarding TC and FCP among 3 groups .Result of multiple logistic regression analysis showed that group(Group B vs Group A ,Group C vs Group A ) ,age , course of disease were the independent risk factors of incidence of carotid atheromatous plaque ,and their odds ratio(OR) were (7 .533 ,40 .418) ,1 .194 ,and 1 .135 .Conclusions :The abnormal level of GGT in patients with T2DM accompanied by NAFLD is correlated with the occurrence and development of carotid atheromatous plaque .

Objective To investigate what kind of obese patients appropriate to adopt the laparoscopic adjustable gastric banding volume reduction surgery.Methods A retrospective study was performed to review the clinical data of 40 patients who required reoperation to remove the gastric banding after LAGB from November 2003 to March 2013 at the Department of Minimally Invasive Surgery,Changhai Hospital.Selected 40 patients who required LAGB from January 2006 to October 2008 as control group.We conducted a case-control study to analyze.Chi-square test and multivariate and non-conditional Logistie regression analysis were used to identify the risk factors of removing of gastric banding.Results Age and gender were not statistically significant different (P ＞ 0.05).Multiple factors of Logistic regression showed that BMI≥35 kg/m2,postoperative clinic visits per year ＜ 3 and on the basis of gastrointestinal disease were risk factors for the removal of gastric banding (Wald =3.908,7.375,5.209,P ＜ 0.05).Conclusion The risk factors for the removal of gastric banding include BMI,postoperative clinic visits and the basis of gastrointestinal disease.In the treatment of obesity with LAGB should take full account of the above factors.

Weight management is an important step in the treatment and management for type 2 diabetes.Obesity,especially visceral fat accumulation,impairs the metabolism function.Excess of visceral fat is closely related to the development of insulin resistance,metabolic syndrome,type 2 diabetes,and cardiovascular disease.Liraglutide,the (GLP-1) analogue,shows its effects on glycaemic control as well as weight reduction which mainly involves reduction of visceral fat.The efficacy characteristics of liraglutide may benefit the comprehensive management of type 2 diabetes.

Sixty male SD rats were separately fed by normal diet or high-fat diet.After eight weeks of highfat diet,these rats were injected low dose streptozotocin (30 mg/kg).Diazoxide or glipizide was administered to the diabetic rats for 4 weeks.The results showed that body weight,serum insulin,and insulin sensitive index were decreased in the obese diabetic rats while the fasting blood glucose,total cholesterol,and triglyceride levels were increased compared with the high-fat diet group ( all P＜0.01 ).Consistent with the results of glipizide,diazoxide treatment lowered blood glucose,improved glucose tolerance,and decreased islet cell apoptosis compared with the diabetes mellitus group ( all P＜0.05 ).The results suggest that diazoxide can improve islet function of obese type 2 diabetic rats via decreasing insulin secretion and thus lessening the load on islet cells.