Objective To investigate the differences in preoperative obesity-related diseases and body composition between adolescents and adults with obesity undergoing metabolic surgery. Methods A total of 454 patients who underwent metabolic surgery in Nanjing Drum Tower Hospital from July 2016 to July 2022 were recruited and divided into the adolescent group (age ≤19 years,n=61) and the adult group (age>19 years,n=393) according to the age of surgery. Preoperative body composition,obesity-related complications and metabolic indicators were compared between the two groups. Results Compared with adolescent group,age,obesity duration,DBP,WHR,trunk body fat percentage,Android fat/Gynoid fat,FPG,HbA1c,2 hPG,TC,TG,UACR,FOL and VitB12 were increased (P<0.05 or P<0.01),while height,weight,HC,total body fat percentage,thigh body fat percentage,Gynoid body fat percentage,FIns,2 hIns,SUA,AKP,eGFR,ALB,Ca2+were decreased in the adult group(P<0.05 or P<0.01).The incidence of prediabetes,grade 1 hypertension,hyperuricemia and psychological diseases was higher(P<0.05 or P<0.01),while the incidence of T2DM,grade 2 hypertension,grade 3 hypertension,liver fibrosis,carotid plaque and OSAHS was lower in adolescent group than in adult group (P<0.05 or P<0.01). Conclusions The preoperative fat distribution is healthier in adolescent patients with obesity undergoing metabolic surgery than that of adults.Obesity-related metabolic complications have already developed in adolescent patients,but less severe than in adult patients. Psychological health and nutritional supplementation should be emphasized in adolescents after metabolic surgery.

Objective To investigate the differences in preoperative obesity-related diseases and body composition between adolescents and adults with obesity undergoing metabolic surgery. Methods A total of 454 patients who underwent metabolic surgery in Nanjing Drum Tower Hospital from July 2016 to July 2022 were recruited and divided into the adolescent group (age ≤19 years,n=61) and the adult group (age>19 years,n=393) according to the age of surgery. Preoperative body composition,obesity-related complications and metabolic indicators were compared between the two groups. Results Compared with adolescent group,age,obesity duration,DBP,WHR,trunk body fat percentage,Android fat/Gynoid fat,FPG,HbA1c,2 hPG,TC,TG,UACR,FOL and VitB12 were increased (P<0.05 or P<0.01),while height,weight,HC,total body fat percentage,thigh body fat percentage,Gynoid body fat percentage,FIns,2 hIns,SUA,AKP,eGFR,ALB,Ca2+were decreased in the adult group(P<0.05 or P<0.01).The incidence of prediabetes,grade 1 hypertension,hyperuricemia and psychological diseases was higher(P<0.05 or P<0.01),while the incidence of T2DM,grade 2 hypertension,grade 3 hypertension,liver fibrosis,carotid plaque and OSAHS was lower in adolescent group than in adult group (P<0.05 or P<0.01). Conclusions The preoperative fat distribution is healthier in adolescent patients with obesity undergoing metabolic surgery than that of adults.Obesity-related metabolic complications have already developed in adolescent patients,but less severe than in adult patients. Psychological health and nutritional supplementation should be emphasized in adolescents after metabolic surgery.

Objective:The aim of this study was to examine the change of serum bone-derived hormones osteocalcin and lipocalin 2 (LCN2) level in patients with active acromegaly, and to further investigate the potential role of osteocalcin and LCN2 in glucose metabolism.Methods:Fifty consecutive patients diagnosed as acromegaly in Nanjing Drum Tower Hospital from December 2016 to August 2018 were recruited. Of those, 41 patients after operations with complete follow-up data were also included. 30 sex, age, and body mass index matched healthy persons as normal controls. Serum osteocalcin and LCN2 levels were compared between controls and patients with acromegaly, as well as at pre- and post- operation periods. Univariate and multivariate linear regression analyses were used to investigate the correlation between bone-derived hormones and glucose metabolism indexes and to determine the independent associations between variables.Results:Compared with normal controls, serum osteocalcin increased [(55.45±34.02 vs 19.46±6.69)ng/ml, P<0.01] and LCN2 levels decreased [(34.15±9.95 vs 57.50±29.75)ng/ml, P<0.01] in patients with acromegaly. Homeostasis model assessment for insulin resistance (HOMA-IR) was also elevated ( P<0.01), but homeostasis model assessment for β cell function (HOMA-β) and area under curve of insulin during 0-120 min of the oral glucose tolerance test (AUC INS) changed non-significantly in acromegaly compared to normal controls ( P>0.05). After operation, with the decrease of serum growth hormone (GH) and insulin-like growth factor 1 (IGF-1), serum osteocalcin level decreased [24.79(18.39, 32.59) vs 43.51(26.73, 65.66)ng/ml, P<0.01] and LCN2 level increased [(45.15±15.33 vs 37.03±9.73)ng/ml, P<0.05] significantly compare to pre-operation levels. In a multivariate linear stepwise regression analysis, lean mass was shown to be the only positive predictor for LCN2 ( β=0.44, P=0.015) and elevated serum IGF-1 was a positive predictor for osteocalcin ( β=0.512, P<0.01). In the multivariate models, low LCN2 ( β=-0.398, P=0.017) and elevated serum osteocalcin ( β=0.553, P=0.001) were predictors for AUC INS, osteocalcin was a positive predictor of HOMA- β ( β=0.519, P=0.004). GH ( β=0.294, P=0.029) and IGF-1( β = 0.428, P=0.002) were all identified as positive predictors of HOMA-IR during multivariate testing in acromegaly patients. Conclusions:Acromegaly patients had increased osteocalcin and decreased LCN2 serum levels, and corresponding alteration was detected with the correction of biochemical abnormalities. Serum osteocalcin and LCN2 were predictors of β-cell function in acromegaly patients. This study adds new evidence for the role of bone in regulating glucose metabolism in acromegaly.

A total of 115 patients with type 2 diabetes recruited from Quanzijie Township Health Service Center were divided into integrated management group (n=54) and specialist management group (n=61). Patients in integrated management group were managed by specialists, general practitioners (GPs) and community nurses jointly; while patients in specialist management group were managed by specialists only. Subjects were followed up every 4 weeks for 24 weeks. Total 366 person/time diabetes education courses were given to subjects in integrated management group during the intervention. After intervention, the fasting glucose, 2 h postprandial glucose and glycosylated hemoglobin were decreased significantly in both groups (P<0.05), while the triglyceride level in the integrated management group was significantly lower than that in the specialist management group (P<0.05). In conclusion, patients with type 2 diabetes managed by integrated mode can achieve similar glucose control effect as specialist management mode in primary care settings and their triglyceride level can be also significantly decreased.

Objective: To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. Methods: Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blocker (ACEI/ARB) were collected. Results: A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05]. Conclusion Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.

OBJECTIVE: To investigate the effect of the chemoprotectant tempol on the anti-tumor activity of cisplatin (DDP). METHODS: The cellular toxicity of tempol in human colon cancer SW480 cells and mouse colon cancer CT26 cells were evaluated using MTT and cell counting kit-8 assays. CalcuSyn software analysis was used to determine the interaction between tempol and DDP in inhibition of the cell viability. A subcutaneous homograft mouse model of colon cancer was established. The mice were randomly divided into control group, tempol group, cisplatin group and tempol + DDP treatment group with intraperitoneal injections of the indicated agents. The tumor size, body weight and lifespan of the mice were measured, and HE staining was used to analyze the cytotoxic effect of the agents on the kidney and liver. Immunohistochemistry and Western blotting were performed to detect the expression of Bax and Bcl2 in the tumor tissue, and TUNEL staining was used to analyze the tumor cell apoptosis. The level of reactive oxygen species (ROS) in the tumor tissue was determined using flow cytometry. RESULTS: Tempol showed inhibitory effects on the viability of SW480 and CT26 cells. CalcuSyn software analysis showed that tempol had a synergistic anti-tumor effect with DDP (CI < 1). In the homograft mouse model, tempol treatment alone did not produce obvious anti-tumor effect. HE staining showed that the combined use of tempol and DDP alleviated DDP-induced fibrogenesis in the kidneys, but tempol also reduced the anti-tumor activity of DDP. Compared with the mice treated with DDP alone, the mice treated with both tempol and DDP had a significantly larger tumor size ( < 0.01) and a shorter lifespan ( < 0.05). Tempol significantly reversed DDP-induced expression of Bax and Bcl2 in the tumor tissue and tumor cell apoptosis ( < 0.001), and obviously reduced the elevation of ROS level in the tumor tissue induced by DDP treatment ( < 0.05). CONCLUSIONS Tempol can attenuate the anti-tumor effect of DDP while reducing the side effects of DDP. Caution must be taken and the risks and benefits should be carefully weighed when considering the use of tempol as an anti-oxidant to reduce the toxicities of DDP.
Animals ; Antineoplastic Agents ; Antioxidants ; Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Cisplatin ; Cyclic N-Oxides ; pharmacology ; Drug Resistance, Neoplasm ; Humans ; Mice ; Spin Labels

Objective To investigate the frequencies of the impaired glucose tolerance and diabetes mellitus in a large cohort of active acromegaly and to identify risk factors associated with the presence of diabetes at diagnosis in these patients.Methods This study included 88 patients with newly diagnosed acromegaly.Patients were further divided into normal glucose tolerance (NGT),impaired glucose regulation (IGR),and diabetes (DM) groups according to oral glucose tolerance test or previous history.Insulin sensitivity and β cell function were also evaluated by homeostasis model assessment (HOMA).Logistic regression analysis was used to explore the independent risk factors for diabetes in patients with acromegaly.Results Impaired glucose regulation was found in 25 (28.4％),and DM in 37(42.0％) acromegaly patients.Compared to NGT and IGR patients,higher proportion of DM patients had family history of diabetes (P＜0.05).Compared to NGT group,higher post-OGTT growth hormone (GH) levels were detected in IGR and DM groups.Insulin-like growth factor 1 (IGF-1) levels were higher in IGR group while lower in DM group (P＜0.01).Homeostasis model assessment for β cell function (HOMA-β) was slightly higher in IGR group,but significantly lower in DM group (P ＜ 0.01).Homeostasis model assessment for insulin resistance (HOMA-IR) was slightly higher in IGR and DM groups but without significant difference among 3 groups.In multivariate analyses,family history of diabetes(OR=12.710,95％ CI 1.176-137.30,P=0.036),age(OR=1.106,95％ CI 1.018-1.202,P=0.017),and GH levels(OR=1.075,95％ CI 1.007-1.147,P=0.030) were independent risk factors of diabetes in acromegaly patients.Conclusion Impaired glucose metabolism is present in nearly 70％ of patients at diagnosis of acromegaly,and is associated with age,family history of diabetes,and higher GH levels,but not with IGF-1 levels.

OBJECTIVE: To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. METHODS: Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin II receptor blocker (ACEI/ARB) were collected. RESULTS: A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05]. CONCLUSIONS Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.
Blood Glucose ; Creatinine ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Humans ; Prospective Studies

Objective To explore the clinical outcomes of the percutaneous radiofrequency nucleoplasty in the treatment of cervical disc herniation.Methods 183 patients with cervical disc herniation were treated with percutaneous radiofrequency nucleoplasty.A retrospective analysis of 183 patients was made,and their effects were evaluated using the VAS and the subjective satisfactory degree of the patients.Results All cases were followed up for 3 to 36 months( average 12 months).There were no complications observed such as hemorrhages,infections and nerve root injurys due to the procedure.One week after operation,symptom remission rate was 58.4％ and perfect rate of subjective satisfaction was 95.1％.At final follow up,symptom remission' rate was 66.1％ and perfect rate of subjective satisfaction was 85.8％.Conclusion Percutaneous radiofrequency nucleoplasty was an effective,minimally invasive and safe procedure to treat cervical disc herniation,and the operative treatment had shown better results.