Objective To investigate the correlation between the improvement of insulin resistance(IR)and T lymphocyte subsets in patients with type 2 diabetes mellitus(T2DM)after intensive insulin therapy.Methods A total of 160 patients with T2DM who were treated in the endocrinology department of our hospital from February 2020 to March 2023 were selected.They were divided into simple T2DM group(n=80)and T2DM combined with family history of diabetes mellitus(FHD)group(n=80)based on whether they had FHD.The changes in blood glucose,pancreatic islet cell function,T lymphocyte subsets,and inflammatory cytokine levels were compared before and after treatment between the two groups.Pearson correlation analysis was used to investigate the correlation between insulin resistance index(HOMA-IR)and T lymphocyte subsets,and multiple linear regression analysis was used to explore the influencing factors for IR in T2DM patients.Results After treatment,the FPG,2 hPG,and coefficient of variation(CV)of blood glucose were lower than before treatment in the T2DM group(P<0.05).In the FHD group,the FPG,2 hPG,bedtime blood glucose,and CV were lower after treatment than before treatment(P<0.05).After treatment,the FPG,2 hPG,and CV were lower in T2DM group than in FHD group(P<0.05).After treatment,FC-P,2 hC-P,HOMA-β and IL-10 were higher(P<0.05),while HOMA-IR,IL-21,IL-1β,CD3+,CD4+,CD8+,CD4+/CD8+were lower than before treatment in both groups(P<0.05).After treatment,FC-P,2 hC-P,HOMA-β and IL-10 were higher,while HOMA-IR,IL-21,IL-1β,CD3+,CD4+,CD8+,CD4+/CD8+were lower in T2DM group than in FHD group(P<0.05).Pearson correlation analysis showed that HOMA-IR was positively correlated with CD3+,CD4+,CD8+,CD4+/CD8+(P<0.05).Multiple linear regression analysis shows that BMI and CD8+are influencing factors for IR in T2DM patients.Conclusions Intensive insulin therapy can improve the islets β cell function inpatients with T2DM and IR.There is a correlation between IR and the increase of CD8+T lymphocyte level in patients.

Objective To construct a Nomogram prediction model based on body position exercise training for patients with chronic constipation. Methods A total of 327 patients with chronic constipation from March 2021 to March 2023 were divided into qualified group (n=279) and unqualified group (n=48) according to their performance in body position exercises. General clinical materials of the patients were collected, and univariate and multivariate Logistic regression analyses were performed to identify risk factors for unqualified body position exercises in patients with chronic constipation; the R software was used to construct a Nomogram model for predicting unqualified body position exercises in patients with chronic constipation, and the receiver operating characteristic (ROC) curve and calibration curve were applied to verify the discrimination and consistency of the Nomogram model. Results There were no significant differences in gender, education level, history of smoking, history of alcohol abuse, history of hypertension, history of abdominal surgery, history of colonoscopy, and correct medication administration ratio between the two groups (P>0.05); the unqualified group had higher age, longer duration of chronic constipation, and a higher proportion of diabetes history compared to the qualified group (P < 0.05); age, duration of chronic constipation, and diabetes history were independent risk factors for unqualified body position exercises in patients with chronic constipation (P < 0.05). The constructed Nomogram prediction model demonstrated excellent discrimination (area under the curve was 0.923, 95%CI, 0.888 to 0.949, with sensitivity and specificity of 87.50% and 81.00% respectively) and consistency (H-L goodness-of-fit test χ²=2.246, P=0.973). The clinical value of this Nomogram model in predicting unqualified body position exercises for patients with chronic constipation was high when the high-risk threshold probability ranged from 0.06 to 0.80. Conclusion Age, duration of chronic constipation, and diabetes history are independent risk factors for unqualified body position exercises in patients with chronic constipation, and the Nomogram model constructed based on these multi-factor results has high discrimination and consistency in predicting unqualified body position exercises for patients with chronic constipation.

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: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Objective:To compare the efficacy and safety of Changsulin ? with Lantus ? in treating patients with type 2 diabetes mellitus (T2DM). Methods:This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin ? or Lantus ? treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results:After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin ? and in Lantus ?, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin ? and Lantus ? in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin ? and Lantus ?, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin ? and Lantus ?, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions:Changsulin ? shows similar efficacy and safety profiles compared with Lantus ? and Changsulin ? treatment was well tolerated in patients with T2DM.

According to the training requirement of the biological-psycho-social medical model to the clinical medical students,in order to promote the comprehensive improvement of medical students' professional knowledge,hands-on ability and human qualities,we design the course of introduction to clinical medicine.Through six major functional modules such as basic professional quality,clinical diagnosis basic technology,basic skills related to the operation,the new progress in clinical medicine and technology,clinical nursing and medical relationship,and medical information management,we build up the core content of integrated course of introduction to clinical medical.In this way,the clinical and related basic knowledge and skills are integrated,the clinical course is closely connected with the basic curriculum,the medical and the humanities exchanges.Through this design,the foundation is laid out for the collaborative efforts of the organ-system of integrated curriculum reform.

Adult ; Humans ; Hypercalcemia ; complications ; Male ; Thyrotoxicosis ; complications

Objective To establish the model of distraction osteogenesis for rabbit femur bone defect, and to observe the effect of icariin on regenerate ossification after distraction osteogenesis, thus to find a method for promoting regenerate ossification after distraction osteogenesis. Methods After the rabbit model of bone defect had been established successfully, the rabbits were equipped with distraction device. And then the 24 modeled rab bits were randomly divided into 2 groups. The experimental group was injected with icariin extract of Herba Epimedii into the interspace of bone distraction, and the control group was given local injection of recombinant human bone morphogenetic protein-2 (rhBMP-2, 100μg/kg) . On week 0, 1, 4 and 6 after the resting period, X-ray photography was carried out in both groups. On week 6 after distraction osteogenesis, the bone specimens of distraction osteogenesis region in both groups were observed by micro-computerized tomography ( CT) for the comparison of bone mass, and bone mineral content and mineral density of the newly-formed bone. Results The results of the features of imageology, and the statistical data of the bone mineral content and density showed that osteogenesis speed and osteogenic quality of the experimental group were superior to those of the control group. Conclusion The rabbit model of distraction osteogenesis for femur bone defect has been established preliminarily, and icariin can promote the speed and quality of regenerate ossification after distraction osteogenesis.

Objective To identify the infection and the replication of Tick-borne encephalitis virus(TBEV) in human neuroblastoma cells.Methods After being inffected with TBEV,the cell culture supernatant of human neuroblastoma cell line SK-N-SH was collected and assayed at different time points.Byusing real-time RT-PCR and plaque assay to measure the titer of virus in the supernatant,the replication andproliferation of TBEV in human neuroblastoma cell was identified.Meanwhile,the morphological change of SK-N-SH after TBEV infection was also visualized by observation under microscope and immunmquorescenceassay.Results Real-time RT-PCR and plaque assay both demonstrated that TBEV could replicate effectively in SK-N-SH cells,the peak titer could reach 2.92× 107 PFU/ml on 3 days post-inoculation.And significant morphological change occured on infected SK-N-SH cells after 2 days post inoculation.By immunofluorescence assay,the virus particles could be detected and visualized.Conclusion TBEV can replicate andproliferate effcctively and cause significant cell morphological changes in human neuroblastoma cell SK-N-SH,which demonstrated that SK-N-SH could be a suitable cell model for TBEV culture.