1.Role and mechanism of platelet-derived growth factor BB in repair of growth plate injury
Hongcheng PENG ; Guoxuan PENG ; Anyi LEI ; Yuan LIN ; Hong SUN ; Xu NING ; Xianwen SHANG ; Jin DENG ; Mingzhi HUANG
Chinese Journal of Tissue Engineering Research 2025;29(7):1497-1503
BACKGROUND:In the initial stage of growth plate injury inflammation,platelet-derived growth factor BB promotes the repair of growth plate injury by promoting mesenchymal progenitor cell infiltration,chondrogenesis,osteogenic response,and regulating bone remodeling. OBJECTIVE:To elucidate the action mechanism of platelet-derived growth factor BB after growth plate injury. METHODS:PubMed,VIP,WanFang,and CNKI databases were used as the literature sources.The search terms were"growth plate injury,bone bridge,platelet-derived growth factor BB,repair"in English and Chinese.Finally,66 articles were screened for this review. RESULTS AND CONCLUSION:Growth plate injury experienced early inflammation,vascular reconstruction,fibroossification,structural remodeling and other pathological processes,accompanied by the crosstalk of chondrocytes,vascular endothelial cells,stem cells,osteoblasts,osteoclasts and other cells.Platelet-derived growth factor BB,as an important factor in the early inflammatory response of injury,regulates the injury repair process by mediating a variety of cellular inflammatory responses.Targeting the inflammatory stimulation mediated by platelet-derived growth factor BB may delay the bone bridge formation process by improving the functional activities of osteoclasts,osteoblasts,and chondrocytes,so as to achieve the injury repair of growth plate.Platelet-derived growth factor BB plays an important role in angiogenesis and bone repair tissue formation at the injured site of growth plate and intrachondral bone lengthening function of uninjured growth plate.Inhibition of the coupling effect between angiogenesis initiated by platelet-derived growth factor BB and intrachondral bone formation may achieve the repair of growth plate injury.
2.Retrospective Study on Tongue Image Characteristics of Patients with Glucolipid Metabolism Disorders with Different Traditional Chinese Medicine Syndromes
Shi LIU ; Yang GAO ; Tao JIANG ; Zhanhong CHEN ; Jialin DENG ; Jiatuo XU
Journal of Traditional Chinese Medicine 2025;66(8):826-833
ObjectiveTo explore the distribution pattern of tongue image characteristics in patients with glucolipid metabolic disorders and its main syndromes. MethodsA total of 841 patients with glucolipid metabolic disorders (disease group), and 380 healthy subjects (control group) were included. The disease group was classified into three syndrome types: 283 cases of liver depression and spleen deficiency syndrome, 311 cases of phlegm-dampness obstruction syndrome, and 247 cases of qi stagnation and blood stasis syndrome. Tongue image data were collected using the TFDA-1 Tongue Diagnosis Instrument, and the TDAS V3.0 software was used to analyze the color, texture, and morphological features of the tongue body (TB) and tongue coating (TC) in patents with different syndromes of disease group (including lightness (L), red-green axis (a), yellow-blue axis (b), luminance (Y), difference between red signal and brightness (Cr), difference between blue signal and brightness (Cb), contrast (CON), angular second moment (ASM), entropy (ENT), mean value (MEAN), tongue coating area/tongue surface area (perAll), and tongue coating area/non-coated area (perPart)). Logistic regression analysis was conducted to identify influencing factors for different syndrome types of glucolipid metabolic disorders. ResultsThe tongue body indicators TB-L, TB-Y, and TB-Cb in the disease group were significantly higher than those in the control group, while TB-a, TB-b, and TB-Cr were significantly lower. The tongue coating indicators TC-L, TC-Y, TC-Cb, perAll, and perPart in the disease group were significantly higher than those in the control group, while TC-a, TC-b, and TC-Cr were significantly lower (P<0.05). Comparing with the different syndromes in disease group, the TB-L and TB-Y of the liver depression and spleen deficiency syndrome, and the phlegm-damp obstruction syndrome were higher than those of the qi stagnation and blood stasis syndrome; the TB-a and TB-Cr of the phlegm-damp obstruction syndrome were lower than those of the qi stagnation and blood stasis syndrome; the perAll of the phlegm-damp obstruction syndrome was higher than that of the qi stagnation and blood stasis syndrome (P<0.05). In the analysis of the morphological characteristics of tongue signs, more spotted tongue in disease group compared with control group, more teeth-marked tongue in liver depression and spleen deficiency syndrome than the other two syndromes, more greasy coating in phlegm-damp obstruction syndrome, and more stasis spots of tongue in qi stagnation and blood stasis syndrome (P<0.05). Logistic regression analysis identified that greasy coating, spotted tongue, stasis spots of tongue, tooth-marked tongue, perAll, and TB-Cb are the influencing factors of liver depression and spleen deficiency syndrome; greasy coating, tooth-marked tongue, TC-Cb, and TC-Cr are the influencing factors of phlegm-damp obstruction syndrome; cracked tongue, stasis spots of tongue, tooth-marked tongue, and TB-Y are the influencing factors of qi stagnation and blood stasis syndrome (P<0.05). ConclusionCompared to healthy individuals, patients with glycolipid metabolic disorder have darker tongue color and thicker, greasy tongue coating. Glycolipid metabolic disorder patients of liver depression and spleen deficiency syndrome exhibit a reddish tongue with finer textures and more tooth marks; patients of phlegm-damp obstruction syndrome have lighter tongue coating with a coarser texture and a higher prevalence of greasy coating; patients of qi stagnation and blood stasis syndrome display lower tongue brightness with a higher prevalence of blood stasis spots.
3.Analysis of clinical characteristics and diagnostic prediction of Qi deficiency and blood stasis syndrome in acute ischemic stroke
Hao XU ; Xu ZHU ; Bo LI ; Xiaodan LIU ; Xihui PAN ; Changqing DENG
Digital Chinese Medicine 2025;8(1):111-122
[Objective] :
To explore the clinical characteristics and methods for syndrome differentiation prediction, as well as to construct a predictive model for Qi deficiency and blood stasis syndrome in patients with acute ischemic stroke (AIS).
[Methods] :
This study employed a retrospective case-control design to analyze patients with AIS who received inpatient treatment at the Neurology Department of The First Hospital of Hunan University of Chinese Medicine from January 1, 2013 to December 31, 2022. AIS patients meeting the diagnostic criteria for Qi deficiency and blood stasis syndrome were stratified into case group, while those without Qi deficiency and blood stasis syndrome were stratified into control group. The demographic characteristics (age and gender), clinical parameters [time from onset to admission, National Institutes of Health Stroke Scale (NIHSS) score, and blood pressure], past medical history, traditional Chinese medicine (TCM) diagnostic characteristics (tongue and pulse), neurological symptoms and signs, imaging findings [magnetic resonance imaging-diffusion weighted imaging (MRI-DWI)], and biochemical indicators of the two groups were collected and compared. The indicators with statistical difference (P < 0.05) in univariate analysis were included in multivariate logistic regression analysis to evaluate their predictive value for the diagnosis of Qi deficiency and blood stasis syndrome, and the predictive model was constructed by receiver operating characteristic (ROC) curve analysis.
[Results] :
The study included 1 035 AIS patients, with 404 cases in case group and 631 cases in control group. Compared with control group, patients in case group were significantly older, had extended onset-to-admission time, lower diastolic blood pressure, and lower NIHSS scores (P < 0.05). Case group showed lower incidence of hypertension history (P < 0.05). Regarding tongue and pulse characteristics, pale and dark tongue colors, white tongue coating, fine pulse, astringent pulse, and sinking pulse were more common in case group. Imaging examinations demonstrated higher proportions of centrum semiovale infarction, cerebral atrophy, and vertebral artery stenosis in case group (P < 0.05). Among biochemical indicators, case group showed higher proportions of elevated fasting blood glucose and glycated hemoglobin (HbA1c), while lower proportions of elevated white blood cell count, reduced hemoglobin, and reduced high-density lipoprotein cholesterol (HDL-C) (P < 0.05). Multivariate logistic regression analysis identified significant predictors for Qi deficiency and blood stasis syndrome including: fine pulse [odds ratio (OR) = 4.38], astringent pulse (OR = 3.67), superficial sensory abnormalities (OR = 1.86), centrum semiovale infarction (OR = 1.57), cerebral atrophy (OR = 1.55), vertebral artery stenosis (OR = 1.62), and elevated HbA1c (OR = 3.52). The ROC curve analysis of the comprehensive prediction model yielded an area under the curve (AUC) of 0.878 [95% confidence interval (CI) = 0.855 – 0.900].
[Conclusion]
This study finds out that Qi deficiency and blood stasis syndrome represents one of the primary types of AIS. Fine pulse, astringent pulse, superficial sensory abnormalities, centrum semiovale infarction, cerebral atrophy, vertebral artery stenosis, elevated blood glucose, elevated HbA1c, pale and dark tongue colors, and white tongue coating are key objective diagnostic indicators for the syndrome differentiation of AIS with Qi deficiency and blood stasis syndrome. Based on these indicators, a syndrome differentiation prediction model has been developed, offering a more objective basis for clinical diagnosis, and help to rapidly identify this syndrome in clinical practice and reduce misdiagnosis and missed diagnosis.
4.ESCRT Mechanism-mediated Repair of Plasma Membrane Damage Induced by Regulatory Cell Death
Tian-Yang FENG ; Le DENG ; Gou XU ; Li LI ; Miao-Miao GUO
Progress in Biochemistry and Biophysics 2025;52(5):1099-1112
The plasma membrane (PM) plays an essential role in maintaining cell homeostasis, therefore, timely and effective repair of damage caused by factors such as mechanical rupture, pore-forming toxins, or pore-forming proteins is crucial for cell survival. PM damage induces membrane rupture and stimulates an immune response. However, damage resulting from regulated cell death processes, including pyroptosis, ferroptosis, and necroptosis, cannot be repaired by simple sealing mechanisms and thus, requires specialized repair machinery. Recent research has identified a PM repair mechanism of regulated cell death-related injury, mediated by the endosomal sorting complexes required for transport (ESCRT) machinery. Here, we review recent progress in elucidating the ESCRT machinery-mediated repair mechanism of PM injury, with particular focus on processes related to regulated cell death. This overview, along with continued research in this field, may provide novel insights into therapeutic targets for diseases associated with dysregulation of regulated cell death pathways.
5.Feiyanning Inhibits Invasion and Metastasis of Non-small Cell Lung Cancer by Regulating EMT via TGF-β1/Smad Signaling Pathway
Xiaojie FU ; Jia YANG ; Kaile LIU ; Wenjie WANG ; Zhenye XU ; Zhongqi WANG ; Haibin DENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):110-120
ObjectiveTo explore the mechanism of the anti-cancer compound formula Feiyanning in inhibiting epithelial-mesenchymal transition (EMT) and invasion and metastasis of non-small cell lung cancer (NSCLC). MethodsCell proliferation and activity were assessed using the cell counting kit-8(CCK-8) assay to evaluate the effect of Feiyanning on the proliferation of A549 and H1299 cells. Wound healing and Transwell assays were conducted to examine Feiyanning's impact on the metastasis of A549 and H1299 cells. The effects of Feiyanning on EMT and the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway proteins in A549 and H1299 cells were detected by Western blot. Exogenous TGF-β1 was used to induce EMT in A549 and H1299 cells. The effects of Feiyanning on TGF-β1-induced NSCLC cell metastasis, EMT, and the TGF-β1/Smad pathway proteins were assessed by wound healing assay, Transwell assay, and Western blot. In vivo, an A549 lung metastasis model was established via tail vein injection in nude mice. A total of 28 SPF male nude mice were randomly divided into four groups: Model (NC) group, Feiyanning low-dose (FYN1) group, Feiyanning high-dose (FYN2) group, and the positive control group (TGF-β receptor kinase inhibitor SB431542 group). The corresponding interventions were performed. After 40 days, the mice were euthanized, and lung metastases were analyzed. The expression of E-cadherin, N-cadherin, p-Smad2, and p-Smad3 in each group was detected by immunohistochemistry (IHC). ResultsAfter Feiyanning intervention, compared to the blank group, Feiyanning inhibited the proliferation of A549 and H1299 cells in a concentration-dependent manner (P<0.01). The metastasis ability of Feiyanning-treated cells was significantly decreased compared to the blank group (P<0.01). The expression of EMT marker proteins N-cadherin and zinc finger transcription factors (Zeb1, Snail, Slug) was significantly reduced in the Feiyanning groups compared to the blank group (P<0.05, P<0.01). The expression of p-Smad2/3, Smad2/3, TβRI, and TβRⅡ, key proteins in the TGF-β1/Smad signaling pathway, was also significantly decreased (P<0.01). In the TGF-β1-induced EMT model, compared to the TGF-β1 group, the cell metastasis ability in the Feiyanning groups was reduced (P<0.01), and the expression levels of N-cadherin, Zeb1, Snail, and Slug were significantly lower (P<0.01). The expression levels of p-Smad2/3, Smad2/3, TβRI, and TβRⅡ were also significantly reduced (P<0.01). In vivo results showed that compared to the model group, the number of lung metastases in the FYN1, FYN2, and SB431542 groups was reduced (P<0.01), and the range of cell infiltration was narrowed. Immunohistochemical results showed that compared to the model group, the expression of E-cadherin in the FYN1, FYN2, and SB431542 groups was increased (P<0.01), the expression of N-cadherin decreased (P<0.05, P<0.01), and the expression of p-Smad2 and p-Smad3, key proteins of the TGF-β1/Smad pathway, was reduced (P<0.01). ConclusionFeiyanning inhibits the invasion and metastasis of NSCLC cells and EMT. The mechanism is related to the inhibition of TGF-β1/Smad signaling pathway.
6.Feiyanning Inhibits Invasion and Metastasis of Non-small Cell Lung Cancer by Regulating EMT via TGF-β1/Smad Signaling Pathway
Xiaojie FU ; Jia YANG ; Kaile LIU ; Wenjie WANG ; Zhenye XU ; Zhongqi WANG ; Haibin DENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):110-120
ObjectiveTo explore the mechanism of the anti-cancer compound formula Feiyanning in inhibiting epithelial-mesenchymal transition (EMT) and invasion and metastasis of non-small cell lung cancer (NSCLC). MethodsCell proliferation and activity were assessed using the cell counting kit-8(CCK-8) assay to evaluate the effect of Feiyanning on the proliferation of A549 and H1299 cells. Wound healing and Transwell assays were conducted to examine Feiyanning's impact on the metastasis of A549 and H1299 cells. The effects of Feiyanning on EMT and the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway proteins in A549 and H1299 cells were detected by Western blot. Exogenous TGF-β1 was used to induce EMT in A549 and H1299 cells. The effects of Feiyanning on TGF-β1-induced NSCLC cell metastasis, EMT, and the TGF-β1/Smad pathway proteins were assessed by wound healing assay, Transwell assay, and Western blot. In vivo, an A549 lung metastasis model was established via tail vein injection in nude mice. A total of 28 SPF male nude mice were randomly divided into four groups: Model (NC) group, Feiyanning low-dose (FYN1) group, Feiyanning high-dose (FYN2) group, and the positive control group (TGF-β receptor kinase inhibitor SB431542 group). The corresponding interventions were performed. After 40 days, the mice were euthanized, and lung metastases were analyzed. The expression of E-cadherin, N-cadherin, p-Smad2, and p-Smad3 in each group was detected by immunohistochemistry (IHC). ResultsAfter Feiyanning intervention, compared to the blank group, Feiyanning inhibited the proliferation of A549 and H1299 cells in a concentration-dependent manner (P<0.01). The metastasis ability of Feiyanning-treated cells was significantly decreased compared to the blank group (P<0.01). The expression of EMT marker proteins N-cadherin and zinc finger transcription factors (Zeb1, Snail, Slug) was significantly reduced in the Feiyanning groups compared to the blank group (P<0.05, P<0.01). The expression of p-Smad2/3, Smad2/3, TβRI, and TβRⅡ, key proteins in the TGF-β1/Smad signaling pathway, was also significantly decreased (P<0.01). In the TGF-β1-induced EMT model, compared to the TGF-β1 group, the cell metastasis ability in the Feiyanning groups was reduced (P<0.01), and the expression levels of N-cadherin, Zeb1, Snail, and Slug were significantly lower (P<0.01). The expression levels of p-Smad2/3, Smad2/3, TβRI, and TβRⅡ were also significantly reduced (P<0.01). In vivo results showed that compared to the model group, the number of lung metastases in the FYN1, FYN2, and SB431542 groups was reduced (P<0.01), and the range of cell infiltration was narrowed. Immunohistochemical results showed that compared to the model group, the expression of E-cadherin in the FYN1, FYN2, and SB431542 groups was increased (P<0.01), the expression of N-cadherin decreased (P<0.05, P<0.01), and the expression of p-Smad2 and p-Smad3, key proteins of the TGF-β1/Smad pathway, was reduced (P<0.01). ConclusionFeiyanning inhibits the invasion and metastasis of NSCLC cells and EMT. The mechanism is related to the inhibition of TGF-β1/Smad signaling pathway.
7.Whole-genome polymorphism of CD36 by third-generation sequencing technology
Jing LIU ; Xiuzhang XU ; Haoqiang DING ; Jing DENG ; Yangkai CHEN ; Wenjie XIA ; Xin YE
Chinese Journal of Blood Transfusion 2025;38(5):610-614
Objective: To analyze CD36 gene by PacBio Sequel Ⅱ the third-generation sequencing technology (TGS), including non-coding sequence, and to investigate the molecular mechanism of CD36 deficiency. Methods: Flow cytometry was performed in the southern Chinese population to detect the CD36 phenotype. Among them, 15 cases of CD36 type I deficiency, 15 cases of CD36 type Ⅱ deficiency, and 10 positive samples were selected. The TGS of the CD36 gene was performed and statistical analysis was conducted. Results: 40 samples (including 15 cases of type I deficiency, 15 cases of type Ⅱ deficiency, and 10 positive samples) were subjected by TGS of CD36 full-length sequences (except part of intron1). A total of 180 polymorphic loci were identified. Among them, 13 kinds were in the coding region, the rest were in non-coding region, with most mutations located in regulatory regions such as the 5′-UTR and 3′-UTR. Conclusion: The high polymorphism of CD36 non-coding regions, particularly in regulatory sequences, provides mechanistic insights into type Ⅱ CD36 deficiency.
8.Application of blood conservation measures with different red blood cell transfusion volumes in obstetrics and their impact on postpartum outcomes
Huimin DENG ; Fengcheng XU ; Meiting LI ; Lan HU ; Xiao WANG ; Shiyu WANG ; Xiaofei YUAN ; Jun ZHENG ; Zehua DONG ; Yuanshan LU ; Shaoheng CHEN
Chinese Journal of Blood Transfusion 2025;38(5):691-698
Objective: To evaluate the application of blood conservation measures in obstetric patients with different red blood cell transfusion volumes and to assess the impact of different transfusion volumes on postpartum outcomes. Methods: A retrospective investigation was conducted on 448 obstetric patients who received blood transfusions at the Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2016 to December 2022. Patients were divided into four groups (1-2 units group, 3-4 units group, 5-6 units group, and >6 units group) based on the volumes of red blood cells (RBCs) transfused during and within 7 days after delivery. The maternal physiological indicators, pre- and postpartum laboratory test indicators, obstetric complications, application of blood conservation measures, use of blood products, and postpartum outcomes were reviewed. The clinical characteristics, application of blood conservation measures, and their impact on postpartum outcomes were compared among different transfusion groups. Results: There were statistically significant differences in the multivariate logistic analysis of history of previous cesarean section (OR=1.781), eclampsia/pre-eclampsia/(OR=1.972) and postpartum blood loss>1 000 mL(OR=1.699)(P<0.05) among different transfusion groups. In terms of blood conservation measures, the more RBCs transfused, the higher the rate of mothers receiving blood conservation measures such as balloon occlusion, arterial ligation, autologous blood transfusion with a cell saver, and hysterectomy. With the increase in the volume of RBCs transfusion, the demand for fresh frozen plasma(FFP), cryoprecipitate, and platelet transfusions also increased. The hospitalization days for the four groups of parturients were 6.0 (4.0-9.0), 7.5 (5.0-14.8), 7.0 (4.5-13.0) and 11.0 (9.0-20.5), respectively (P<0.05) and the rates of ICU transfer were 2.0% (5/250), 9.4% (12/128),18.2% (6/33) and 51.4% (19/37), respectively (P<0.05). Both increased significantly with the increase in the volume of RBCs transfusion, and the differences between groups were statistically significant. Conclusion: Parturients who received higher volume of RBCs had multiple risks factors for bleeding before childbirth, had higher postpartum blood loss, and had a higher rate of application of various blood conservation measures. In addition, an increase in the volume of RBCs transfusion may have adverse effects on postpartum recovery.
9.Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Wenqi FAN ; Chao DENG ; Ruoyao XU ; Zhenqi LIU ; Richard David LESLIE ; Zhiguang ZHOU ; Xia LI
Diabetes & Metabolism Journal 2025;49(2):235-251
Background:
Automated insulin delivery (AID) systems studies are upsurging, half of which were published in the last 5 years. We aimed to evaluate the efficacy and safety of AID systems in patients with type 1 diabetes mellitus (T1DM).
Methods:
We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov until August 31, 2023. Randomized clinical trials that compared AID systems with other insulin-based treatments in patients with T1DM were considered eligible. Studies characteristics and glycemic metrics was extracted by three researchers independently.
Results:
Sixty-five trials (3,623 patients) were included. The percentage of time in range (TIR) was 11.74% (95% confidence interval [CI], 9.37 to 14.12; P<0.001) higher with AID systems compared with control treatments. Patients on AID systems had more pronounced improvement of time below range when diabetes duration was more than 20 years (–1.80% vs. –0.86%, P=0.031) and baseline glycosylated hemoglobin lower than 7.5% (–1.93% vs. –0.87%, P=0.033). Dual-hormone full closed-loop systems revealed a greater improvement in TIR compared with hybrid closed-loop systems (–19.64% vs. –10.87%). Notably, glycemia risk index (GRI) (–3.74; 95% CI, –6.34 to –1.14; P<0.01) was also improved with AID therapy.
Conclusion
AID systems showed significant advantages compared to other insulin-based treatments in improving glucose control represented by TIR and GRI in patients with T1DM, with more favorable effect in euglycemia by dual-hormone full closedloop systems as well as less hypoglycemia for patients who are within target for glycemic control and have longer diabetes duration.
10.Efficacy and Safety of Automated Insulin Delivery Systems in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Wenqi FAN ; Chao DENG ; Ruoyao XU ; Zhenqi LIU ; Richard David LESLIE ; Zhiguang ZHOU ; Xia LI
Diabetes & Metabolism Journal 2025;49(2):235-251
Background:
Automated insulin delivery (AID) systems studies are upsurging, half of which were published in the last 5 years. We aimed to evaluate the efficacy and safety of AID systems in patients with type 1 diabetes mellitus (T1DM).
Methods:
We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov until August 31, 2023. Randomized clinical trials that compared AID systems with other insulin-based treatments in patients with T1DM were considered eligible. Studies characteristics and glycemic metrics was extracted by three researchers independently.
Results:
Sixty-five trials (3,623 patients) were included. The percentage of time in range (TIR) was 11.74% (95% confidence interval [CI], 9.37 to 14.12; P<0.001) higher with AID systems compared with control treatments. Patients on AID systems had more pronounced improvement of time below range when diabetes duration was more than 20 years (–1.80% vs. –0.86%, P=0.031) and baseline glycosylated hemoglobin lower than 7.5% (–1.93% vs. –0.87%, P=0.033). Dual-hormone full closed-loop systems revealed a greater improvement in TIR compared with hybrid closed-loop systems (–19.64% vs. –10.87%). Notably, glycemia risk index (GRI) (–3.74; 95% CI, –6.34 to –1.14; P<0.01) was also improved with AID therapy.
Conclusion
AID systems showed significant advantages compared to other insulin-based treatments in improving glucose control represented by TIR and GRI in patients with T1DM, with more favorable effect in euglycemia by dual-hormone full closedloop systems as well as less hypoglycemia for patients who are within target for glycemic control and have longer diabetes duration.

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