Morphea alopecia is a rare secondary cicatricial alopecia, often caused by linear scleroderma of the scalp. When hair loss appears as the only symptom of morphea, it is easily confused with other localized alopecia. The diagnosis of morphea alopecia depends on histopathologic and dermoscopic examinations. In order to improve the understanding of morphea alopecia among clinicians, this review summarizes research progress in its pathogenesis, clinical and pathological characteristics, diagnosis and treatment.

Morphea alopecia is a rare secondary cicatricial alopecia, often caused by linear scleroderma of the scalp. When hair loss appears as the only symptom of morphea, it is easily confused with other localized alopecia. The diagnosis of morphea alopecia depends on histopathologic and dermoscopic examinations. In order to improve the understanding of morphea alopecia among clinicians, this review summarizes research progress in its pathogenesis, clinical and pathological characteristics, diagnosis and treatment.

A 65-year-old female patient with paranoid schizophrenia switched to amisulpride due to poor treatment efficacy with risperidone, and gradually increased the dosage (0.1 g twice daily for 3 days, 0.2 g, twice daily for 2 days, and finally 0.4 g in the morning and 0.2 g in the evening). After 4 days of medication, electrocardiogram showed sinus bradycardia, with heart rate 49 beats/min and QT interval 492 ms; after 7 days of medication, dynamic electrocardiogram showed heart rate 25 beats/min (average heart rate 42 beats/min) and sinus arrest (207 R-R intervals greater than 2.0 s, with a maximum of 2.47 s). Sinus arrest in the patient mostly occurred at night. Amisulpride was reduced to 0.2 g once daily orally, and ECG monitoring was given. The next day, echocardiography showed left ventricular dyskinesia, mild mitral regurgitation, and abnormal left ventricular filling. It was considered that sinus arrest may be related to amisulpride. The drug was discontinued immediately, the dose of olanzapine increased from 5 mg/d to 10 mg/d, and other treatments remain unchanged. On the day after discontinuation of amisulpride, the number of sinus arrest in electrocardiogram monitoring significantly decreased compared to before. Three days after discontinuation, no sinus arrest was found on the dynamic electrocardiogram; 26 days later, the ECG showed sinus rhythm, with a heart rate of 60 beats/min.

A 65-year-old female patient with paranoid schizophrenia switched to amisulpride due to poor treatment efficacy with risperidone, and gradually increased the dosage (0.1 g twice daily for 3 days, 0.2 g, twice daily for 2 days, and finally 0.4 g in the morning and 0.2 g in the evening). After 4 days of medication, electrocardiogram showed sinus bradycardia, with heart rate 49 beats/min and QT interval 492 ms; after 7 days of medication, dynamic electrocardiogram showed heart rate 25 beats/min (average heart rate 42 beats/min) and sinus arrest (207 R-R intervals greater than 2.0 s, with a maximum of 2.47 s). Sinus arrest in the patient mostly occurred at night. Amisulpride was reduced to 0.2 g once daily orally, and ECG monitoring was given. The next day, echocardiography showed left ventricular dyskinesia, mild mitral regurgitation, and abnormal left ventricular filling. It was considered that sinus arrest may be related to amisulpride. The drug was discontinued immediately, the dose of olanzapine increased from 5 mg/d to 10 mg/d, and other treatments remain unchanged. On the day after discontinuation of amisulpride, the number of sinus arrest in electrocardiogram monitoring significantly decreased compared to before. Three days after discontinuation, no sinus arrest was found on the dynamic electrocardiogram; 26 days later, the ECG showed sinus rhythm, with a heart rate of 60 beats/min.

Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual's health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique "continuous glucose monitoring" (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes (P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI (P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.
Humans ; Glucose ; Blood Glucose ; Insulin Resistance/physiology* ; Diabetes Mellitus, Type 2/diagnosis* ; Blood Glucose Self-Monitoring ; Time Factors ; Insulin

Background::The potential impact of β cell function and insulin sensitivity on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains uncertain. We aimed to investigate the association between β cell dysfunction, insulin resistance, and the composite adverse pregnancy outcomes.Methods::This observational study included 482 women diagnosed with GDM during pregnancy. Quantitative metrics on β cell function and insulin sensitivity during pregnancy were calculated using traditional equations. The association of β cell dysfunction and insulin resistance with the risk of the composite adverse pregnancy outcomes was investigated using multivariable-adjusted logistic regression models.Results::Multivariable-adjusted odds ratios (ORs) of adverse pregnancy outcomes across quartiles of homeostatic model assessment for insulin resistance (HOMA-IR) were 1.00, 0.95, 1.34, and 2.25, respectively ( P for trend = 0.011). When HOMA-IR was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 1.34 (95% confidence interval 1.16-1.56) for each 1-unit increase in HOMA-IR. Multivariable-adjusted ORs of adverse pregnancy outcomes across quartiles of homeostatic model assessment for β cell function (HOMA-β) were 1.00, 0.51, 0.60, and 0.53, respectively ( P for trend = 0.068). When HOMA-β was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 0.57 (95% CI 0.24-0.90) for each 1-unit increase in HOMA-β. However, other quantitative metrics were not associated with the composite adverse pregnancy outcomes. Conclusions::We demonstrated a significant association of β cell function and insulin sensitivity with the risk of adverse pregnancy outcomes. We have provided additional evidence on the early identification of adverse pregnancy outcomes besides the glycemic values.

Objective:To compare the efficacy and safety of Tonghua Dongbao′s insulin aspart injection (Rishulin) and NovoRapid (Novo Nordisk) in the treatment of diabetes.Methods:A 26-week, randomized, open-label, parallel-group, positive control drug and non-inferiority trial was conducted in 23 centers in China. A total of 563 diabetes with poor blood glucose control treated with insulin for at least 3 months before were included. The subjects were randomized(stratified block random method) into those receiving Rishulin or NovoRapid at a ratio of 3∶1. Both groups were combined with basal insulin (Lantus). The primary endpoint was the change in glycosylated hemoglobin (HbA1c) from baseline to the end of 24 weeks of treatment.Results:For full analysis set, after 24 weeks of treatment, HbA1c level of Ruishulin group decreased from (8.66±1.28)% to (7.77±1.09)% ( P<0.001), and that of NovoRapid group decreased from (8.47±1.28) % to (7.65±0.97) % ( P<0.001). Treatment difference in HbA1c (NovoRapid group-Ruishulin group) was -0.061% (95% CI -0.320-0.199). HbA1c<7.0% target reacing rates were 24.26% and 21.21% ( P=0.456), and HbA1c<6.5% target reacing rates were 9.65% and 6.82% ( P=0.310) in Ruishulin group and NovoRapid group, repectively. The standard 2 hours postprandial blood glucose (2hPG) in Ruishulin group decreased from (16.23±5.22) mmol/L to (12.65±4.57) mmol/L ( P<0.001), and 2hPG in NovoRapid group decreased from (16.13±5.37) mmol/L to (11.91)±4.21) mmol/L ( P<0.001). The fingertips blood glucose at 7-point of both groups exhibited varying degrees of reduction compared with those at baseline, repectively. Positive ratios of specific antibodies were 31.68% in Ruishulin group and 36.36% in NovoRapid group ( P=0.320). Ratios of negative to positive were 7.43% and 10.61% ( P=0.360), and ratios of positive to negative were 10.40% and 7.58% ( P=0.360) in Ruishulin group and NovoRapid group, respectively. The incidence of hypoglycemia was 60.05% and 55.40% ( P=0.371), and the incidence of adverse events was 76.60% and 77.70% ( P=0.818) in Ruishulin group and NovoRapid group, respectively. Conclusions:Rishulin is not inferior to NovoRapid, and has shown good efficacy and safety. It can be an ideal choice for clinicians in patients with poor blood glucose control with insulin.

Background In the process of greenhouse working, labor intensity is high and repetitive work involves multiple body parts such as limbs, neck, upper back, and lower back. The prevalence and comorbidity of work-related musculoskeletal disorders (WMSDs) in greenhouse workers are worthy of attention. Objective This study is conducted to investigate the prevalence and comorbidity, as well as potential influencing factors of WMSDs in greenhouse workers. Methods A total of 722 greenhouse workers were selected as the subjects for a cross-sectional epidemiological survey. Through questionnaire survey and physical examination, basic information of the subjects and the prevalence of WMSDs were collected. The participants were divided into low, medium, and high cumulative exposure groups by cumulative exposure index matrix. Chi-square test was used to analyze the difference of prevalence among different cumulative exposure levels, the correlation between the prevalence of WMSDs in paired sites was calculated as prevalence ratio (PR) by using the log-binomial model, the prevalence of multi-site WMSDs in each group was compared by Wilcoxon rank sum test, and the influencing factors of multi-site WMSDs were evaluated by multi-classification logistic regression model. Results The prevalence rate of WMSDs in the greenhouse workers was 78.7% (568/722). The main affected sites of body were lower back, legs, neck, and shoulders, and associated prevalence rates were 47.6%, 46.0%, 27.1%, and 23.8%, respectively. By constructing a cumulative exposure index matrix, the low, medium, and high cumulative exposure groups contained 121, 196, and 405 workers respectively. The prevalence rates of WMSDs in lower back, legs, or shoulders were significantly different among groups with different exposure levels (P<0.05), and the prevalence rates increased with higher cumulative exposure levels (lower back, \begin{document}${χ} _{{{\rm{trend}}}} ^2$\end{document}=11.144, P<0.05; legs, \begin{document}${χ} _{{{\rm{trend}}}} ^2$\end{document}=6.767, P<0.05; shoulders, \begin{document}${χ} _{{{\rm{trend}}}} ^2$\end{document}=15.666, P<0.05). The results of log-binomial model found that lower back and legs (PR values were 1.57 and 1.43, respectively) as well as neck and shoulders (PR values were 2.00 and 2.07, respectively) among the main affected parts have a strong association with comorbidities. The prevalence of multi-site WMSDs showed that 50.4% of the workers had comorbidity of two or more sites of WMSDs. The results of multi-classification logistic regression analysis indicated that the influencing factors of WMSDs in two sites involved high-level cumulative exposure (OR=2.41, 95%CI: 1.34-4.33) and female (OR=3.27, 95%CI: 2.07-5.16); the influencing factors of WMSDs in three or more sites also included medium-level cumulative exposure (OR=3.78, 95%CI: 1.70-8.39), high-level cumulative exposure (OR=7.34, 95%CI: 3.41-15.80), and female (OR=5.66, 95%CI: 3.48-9.22). Conclusion In this study, the prevalence rates of WMSDs in lower back, legs, neck, and shoulders are high among selected solar greenhouse workers, and WMSDs comorbidity of lower back-legs and neck-shoulders are identified. Greenhouse workers with high cumulative exposure level and female workers report more WMSDs comorbidities in two or more sites.

Background Due to long working time and complex and changeable lighting conditions, greenhouse workers' anisometropia is an issue of concern. Objective This study is conducted to evaluate the relationship between solar greenhouse working and anisometropia of workers. Methods Subjects of a solar greenhouse group and a non-greenhouse group in northwest area of China were selected. Questionnaire survey was used to collect general demographicinformation. Standard Logarithmic Visual Acuity Chart (GB 11533—2011) was used to measure naked eye vision before working, the absolute value of binocular visual acuity difference was calculated and converted into classification variables, and both anisometropia absolute value and classification variables of anisometropia were used as indicators to compare the difference of the two groups. A cumulative exposure index that multiplies exposure time and number of greenhouses was further introduced to evaluate cumulative exposure levels of the greenhouse workers and was used to divide them into low, medium, and high cumulative exposure subgroups. Generalized linear model and logistic regression model were used to analyze possible risk factors associated with anisometropia. Results A total of 1002 subjects were enrolled in this study, including 739 workers in the greenhouse group and 263 workers in the non-greenhouse group. The medians (interquartile intervals) of anisometropia of the greenhouse group and non-greenhouse group were 0.1 (0, 0.2) and 0 (0, 0.1) respectively, and the difference was statistically significant (P<0.05). The proportions of anisometropia=0, ≤0.2, and >0.2 in the greenhouse group were 34.2%, 55.2%, and 10.6%, respectively, and those in the non-greenhouse group were 58.2%, 34.6%, and 7.2%, respectively. The difference of anisometropia distribution between the two groups was statistically significant (P<0.05). According to the cumulative exposure index, the greenhouse group was divided into low, medium, and high cumulative exposure subgroups, with 154 (21.0%), 188 (25.6%), and 392 (53.4%) workers, respectively. There was no statistical significance in anisometropia among workers with different cumulative exposure levels (P>0.05). The results of multiple generalized linear analysis showed that greenhouse working was a risk factor of anisometropia (b=0.053, P<0.05), and the results of multiple logistic regression analysis showed that greenhouse working was associated with an increased risk of anisometropia (OR=2.586, 95%CI: 1.473-4.539). The results of multiple generalized linear analysis showed that medium exposure level increased the degree of anisometropia after adjusting age, gender, and other factors (b=0.054, P<0.05). Conclusion Solar greenhouse working may be a risk factor for increasing anisometropia in workers.