ObjectiveTo sum up the clinical features of 5α-reductase type 2 deficiency （5α-RD2） complicated by central precocious puberty （CPP）， and provide experience for clinicians. MethodsA retrospective review was conducted of child patients with 5α-RD2 followed up to puberty at a single tertiary pediatric center， in whom 6 cases developed CRP. Clinical characteristics and treatment history of them were analyzed. A literature review was also performed to investigate possible mechanisms underlying the co-occurrence of 5α-RD2 and CPP. ResultsThe median age at initial presentation was 5.55 years （IQR 3.50-7.20）. Common clinical features included micropenis and hypospadias. Median stretched penile length （SPL） was 2.25 cm （IQR 1.8-2.8）， with an SPL-SDS of -4.5 （IQR -3.1 to -5.8）. Median external masculinization score （EMS） and Prader scores were 8.5 （IQR 5.0-9.0） and 4.5 （IQR 3.0-5.0）， respectively. Pubertal onset occurred at a median age of 8.70 years （IQR 7.80-9.00）. Three patients were overweight or obese. Five had received 2.5% dihydrotestosterone （DHT） gel prior to pubertal onset， with a median cumulative dose of 205.5 mg/kg （IQR 72.0-660.3 mg/kg） with DHT gel therapy. Notably， one patient with normal body mass index （BMI） and no history of androgen or gonadotropin therapy also exhibited early pubertal onset at 8.4 years. ConclusionCPP in children with 5α-RD2 may be associated with prior dihydrotestosterone （DHT） gel therapy and elevated BMI； however， a potential intrinsic link to the underlying disorder cannot be excluded. Further studies are needed to elucidate the pathophysiological mechanisms.

AIM:To establish a model of recurrent hypoglycemia(RH)in mice with type 1 diabetes mellitus(T1DM)and to investigate the expression and effects of glucagon-like peptide-1(GLP-1)in the intestines of the model mice.METHODS:The T1DM model was established by induction with streptozotocin.Starting from the 15th day of T1DM,the mice in RH group were injected intraperitoneally with short-acting insulin,experiencing 1 episode of hyperin-sulinemic hypoglycemia every 3 days over 5 episodes,to establish the RH model in T1DM mice.Body weight,blood glu-cose,and activity status of the mice were recorded.Enzyme-linked immunosorbent assay(ELISA)was used to measure plasma adrenaline,glucagon(GCG),GLP-1,and somatostatin(SST)levels after the fifth episode of hypoglycemia for 60 min.Immunofluorescence staining was utilized to detect the expression of intestinal GLP-1 and hormone secretions from pancreatic α and δ cells in each group.Western blot was employed to detect protein expressions of GLP-1,GLP-1 receptor(GLP-1R),and prohormone convertase 1/3(PC1/3)in the intestine.RESULTS:Blood glucose and body weight met the standards for T1DM mice.During the 5 episodes of hypoglycemia,blood glucose levels in the RH group dropped to(3.3±0.5)mmol/L for more than 60 min during each episode of hypoglycemia,along with levels of plasma adrenaline and gluca-gon and the behavioral changes of RH mice during hypoglycemia,which met the modeling criteria of RH and impaired hy-poglycemic counterregulation in diabetic mice.ELISA detection showed that the plasma adrenaline and GCG levels were lower in RH group than those in T1DM group(P<0.01),while the plasma active GLP-1 and SST levels in mice were sig-nificantly higher in RH group(P<0.01).Immunofluorescence analysis showed that intestinal GLP-1 expression and pan-creatic SST secretion increased in RH group(P<0.01),while GCG secretion decreased(P<0.01).Western blot analysis showed that the levels of intestinal active GLP-1 and GLP-1R in RH group were significantly higher than those in T1DM group(P<0.01).CONCLUSION:Recurrent hypoglycemia in T1DM mice leads to increased intestinal GLP-1 expres-sion and secretion,which is closely related to the formation or aggravation of impaired hypoglycemic counterregulation.

OBJECTIVE To systematically evaluate the regulatory effect of liraglutide on hypoglycemia in patients with type 1 diabetes mellitus （T1DM） and provide evidence for the prevention and control of hypoglycemia in the clinical treatment of T1DM. METHODS Electronic databases including The Cochrane Library， PubMed， Embase， Web of Science， China Biology Medicine Disc （CBM）， CNKI， Wanfang database， and VIP database were searched from the inception of the databases to June 30， 2023. The clinical randomized controlled trials （RCTs） of liraglutide on hypoglycemia in T1DM patients were screened according to inclusion and exclusion criteria. Data extraction， grouping， and subgroup meta-analysis were conducted for the included studies. RESULTS A total of 11 RCTs involving 1 685 patients were ultimately included. Meta-analysis results showed that treatment with 1.2 mg liraglutide could reduce the frequency of hypoglycemia in patients with T1DM [OR＝0.81， 95%CI （0.74， 0.88）， P＜0.01]， while treatment with 1.8 mg liraglutide could increase the frequency of hypoglycemia [OR＝1.33， 95%CI （1.23， 1.44）， P＜0.01]. The effect of liraglutide on hypoglycemia in patients with T1DM was not correlated with the duration of hypoglycemia [MD＝ －0.29， 95%CI （－1.21， 0.63）， P＝0.53]， and did not increase the incidence of severe hypoglycemia in these patients [OR＝0.87， 95%CI （0.57， 1.33）， P＝0.53]. Liraglutide could reduce the levels of glycated hemoglobin [MD＝－1.39， 95%CI （－2.65， －0.13）， P＝0.03]， weight [MD＝－4.28， 95%CI （－5.01， －3.55）， P＜0.01]， and body mass index [MD＝－1.20， 95%CI （－1.80， －0.60）， P＜0.01] in them. CONCLUSIONS Liraglutide has a bidirectional regulatory effect on hypoglycemia in patients with T1DM， which is correlated with the dose of liraglutide. An appropriate dose of liraglutide （1.2 mg） can inhibit hypoglycemia in these patients， while an increased dose of liraglutide （1.8 mg） can promote hypoglycemia in them.

Objective To investigate the relationship between the marrow edema and general clinical index,quadriceps muscle area,and the meniscus grade of knee osteoarthritis(OA).Methods 72 patients were collected with knee OA in our hospital, underwent X-ray and routine MRI examination of knee, and the same X-ray and MRI were reviewed at 12 months later in different time point.The K-L grading, bone marrow edema score, meniscal grading and VAS score of each knee joint were evaluated.The t-test and Rank-sum test were used to compare the two groups of general data, Spearman was used to perform bivariate correlation analysis.Results The age and VAS score of bone marrow edema group at the initial follow-up were significantly lower than those without edema group(P<0.05),the degree of marrow edema was moderately correlated with age and VAS score, and was not significantly correlated with other indexes.12 months later, BMI and the area of quadriceps femoris in the group with marrow edema were different from those in the group without bone marrow edema(P<0.05), the degree of marrow edema was moderately correlated with age, quadriceps area and VAS.Conclusion The range of marrow edema was related to age, quadriceps area, BMI index and VAS score in MRI.The MRI measurement could reflect the progression of knee OA more than that of X-ray.It also revealed some factors related to the progression of knee OA.

OBJECTIVE: To study the immunomodulatory effects of Astragalus polysaccharide (APS) in type 1 diabetic mice. METHODS: A mouse model of type 1 diabetes mellitus was established by intraperitoneal injection of multiple low dose streptozotocin (MLD-STZ). The diabetic mice were intraperitoneally administered 100, 200, 400 mg/kg APS or 1 ml normal saline (NS) every day respectively, then the diabetic mice were sacrificed after 15 or 30 days of treatment. The effect of APS on insulitis was determined via pancreatic histological analysis. Serum insulin autoantibody (IAA) levels were measured by radio-immunoassay (RIA). Proliferation ability of splenocytes to concanavalin A was tested by using [(3)H] thymidine incorporation assay. The levels of cytokine interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) secreted by splenocytes were determined by enzyme linked immunosorbent assay (ELISA) method, and the expression of peroxisome proliferator-activated receptor gamma (PPARgamma) in spleens was characterized using Western-blot analysis. RESULTS: Attenuated insulitis, down-regulation of the serum IAA levels and Th1/Th2 cytokine ratio, decrease of the proliferation ability of splenocytes to concanavalin A, and up-regulation of the PPARgamma levels in spleens showed a significant time- and dose-dependent response to APS treatment as compared with the NS-treated group. CONCLUSION: APS possesses immunotherapeutic effects on mice with type 1 diabetes mellitus through improving the cell- and humoral-mediated immunity.

The animal experiment studies have demonstrated that hyperthermia is a strong teratogen to many kinds of animal with high incidence of neural tube defects(NTD).Epidermiological investigation showed that hyperthermia was closely related to the acencephaly and excenphaly in human being,but little was known about the distinct mechanism of NTD induced by hyperthermia.In order to study the developmental mechanism of NTD induced by hyperthermia,we observed the effects of hyperthermia on the neuroepithelial cells in primary culture.The neural tubes of the hamster embryos on 10 d after fertilization were obtained.the neuroepithelia were dissociated and then seeded at the density of 1×106 cells per well.The cells were divided into experimental and control groups randomly.The experimental groups were exposed to 42 C for 20 min,whereas groups exposed to 37 Cserved as control.After treatment of hyperthermia,the cells were incubated continuously at 37 C in a 95%air/5%CO2 humidified incubator,the culture was terminated after different intervals.Phase-contrast microscopy.scanning electron microscopy.transmission electron microscopy,MTT assay,agarose gel electrophoresis analysis,TUNEL detection,immunocytochemistryand image analysis were made.The results of the experimental groups indicated that the floating cells and apoptotic cells increased in number,the neurites of the cells were shortened even disappeared,the survival cells decreased in number,the ultrastructure of the cells demonstrated distinct abnormal changes,the function of mitochondria was impaired,the expressions of both bcl-2 and bax were abnormal.The above results suggest that hyperthermia may induce apoptosis of neuroepithelial cells,duringwhich bcl-2 and bax genes may play important regulatory roles.