A 35-year-old male patient with type 2 diabetes mellitus was treated with metformin and dapagliflozin orally for a long time. Due to poor glycemic control and overweight, the treatment was adjusted to subcutaneous injection of semaglutide 0.25 mg once a week plus 1 metformin and empagliflozin tablet orally twice daily. The patient experienced abdominal bloating and significant satiety after the first dose, which did not attract attention, and metformin and empagliflozin tablets were not discontinued. Three days later, he developed persistent epigastric pain, and laboratory tests indicated blood ketone body (β-hydroxybutyrate) 4.70 mmol/L. Despite treatments with lansoprazole, anisodamine, metoclopramide, and dezocine, the symptoms was not alleviated. Gastrointestinal decompression was performed, which led to a slight improvement in abdominal pain. An immediate abdominal CT scan revealed gastric retention. The patient′s gastric retention was considered to be associated with the administration of semaglutide. The following day′s laboratory tests indicated carbon dioxide combining power 2.36 mmol/L, suggesting the occurrence of diabetic ketoacidosis, which was hypothesized to be related to empagliflozin. The original hypoglycemic regimen was discontinued, insulin pump therapy was given with blood glucose level monitoring, and fasting, gastrointestinal decompression, fluid resuscitation, and acid suppression was applied. The patient′s symptoms were significantly improved, and the ketone body levels gradually decreased. After 3 days of treatments, the patient began to eat, and after 6 days, he returned to a normal diet without further abdominal pain or bloating. The ketone body levels and carbon dioxide combining power returned to normal, and the hypoglycemic regimen was adjusted to lispro insulin plus acarbose.

A 35-year-old male patient with type 2 diabetes mellitus was treated with metformin and dapagliflozin orally for a long time. Due to poor glycemic control and overweight, the treatment was adjusted to subcutaneous injection of semaglutide 0.25 mg once a week plus 1 metformin and empagliflozin tablet orally twice daily. The patient experienced abdominal bloating and significant satiety after the first dose, which did not attract attention, and metformin and empagliflozin tablets were not discontinued. Three days later, he developed persistent epigastric pain, and laboratory tests indicated blood ketone body (β-hydroxybutyrate) 4.70 mmol/L. Despite treatments with lansoprazole, anisodamine, metoclopramide, and dezocine, the symptoms was not alleviated. Gastrointestinal decompression was performed, which led to a slight improvement in abdominal pain. An immediate abdominal CT scan revealed gastric retention. The patient′s gastric retention was considered to be associated with the administration of semaglutide. The following day′s laboratory tests indicated carbon dioxide combining power 2.36 mmol/L, suggesting the occurrence of diabetic ketoacidosis, which was hypothesized to be related to empagliflozin. The original hypoglycemic regimen was discontinued, insulin pump therapy was given with blood glucose level monitoring, and fasting, gastrointestinal decompression, fluid resuscitation, and acid suppression was applied. The patient′s symptoms were significantly improved, and the ketone body levels gradually decreased. After 3 days of treatments, the patient began to eat, and after 6 days, he returned to a normal diet without further abdominal pain or bloating. The ketone body levels and carbon dioxide combining power returned to normal, and the hypoglycemic regimen was adjusted to lispro insulin plus acarbose.

Objective: To understand epidemiological characteristics of echinococcosis among children and adolescents in Lhasa, and to provide basic data and theoretical support for echinococcosis prevention and control. Methods: The data of echinococcosis screening in Lhasa in 2017 were collected from 3-18 years old, and portable ultrasound and serum echinococcosis antibody tests were used for screening, and the diagnosis was made based on the epidemiological history and clinical manifestations. Results: The overall echinococcosis detection rate of children and adolescents aged 3-18 years in Lhasa was 0.12% (114/95 835).Among different age groups, the echinococcosis rate of children and adolescents aged 16 to 18 was the highest (0.17%). Among the population with different education levels, the echinococcosis rate of children and adolescents with primary education level was the highest (0.45%).The echinococcosis detection rate of herdsmen was the highest among different occupational groups (0.59%). Among the population with different living patterns, echinococcosis rate was the highest (0.70%) in "settled in winter and nomadic in summer" group. The rate of echinococcosis of children and adolescents were the highest in "nomadism" group and "half farming and half nomadism" group (both 0.20%) among different family production mode. Among different endemic counties, the echinococcosis detection rate of children and adolescents in Dangxiong county and Mozhugongka county were the highest, both of which are 0.18%.All the above differences are statistically significant(χ2=16.77,23.76,69.76,16.49,14.74,25.25,P<0.01).There was no significant difference in echinococcosis detection rate between boys and girls(P>0.05). Conclusion Echinococcosis is more likely to be detected in children and adolescents who are older and have a lower education level, whose production and lifestyle are involved in animal husbandry, and who live at a higher altitude. Therefore, the prevention and control of echinococcosis among children and adolescents, especially the health education, should be the focus of the government’s work.

Objective To investigate the influence of metabolic syndrome (MS) on bone metabolism in middle-aged male patients with MS by measuring indicators of bone metabolism.Methods Among people who underwent physical examination from October 2010 to May 2013,110 middle-aged male patients with MS were selected and enrolled in MS group and 36 middle-aged men without MS were selected and enrolled in non-MS group.In MS group,27 patients with osteoporosis were enrolled in MS with osteoporosis group and 36 patients with decreased bone mass were enrolled in MS with decreased bone mass group.In each group:body mass index (BMI) and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated;systolic blood pressure (SBP),diastolic blood pressure (DBP) and waist circumference was measured;blood biochemical indicators including fasting plasma glucose (FPG),2 h postprandial plasma glucose (2 h PG),fasting insulin (FINS),total cholesterol (TC),triglyceride (TG),low density lipoprotein-cholesterol (LDL-C) and high density hpoprotein-cholesterol (HDL-C) was tested; bone metabolic indicators including serum calcium,phosphate,alkaline phosphatase,25-hydroxy vitamin D [25-(OH)D3],procollagen type Ⅰ amino-terminal prcpeptide (PINP),parathyroid hormone (PTH),osteocalcin and urinary C-terminal telopeptide of type Ⅰ collagen (U-CTX),urine calcium,urine creatinine (Cr) were tested;bone mineral density(BMD) of lumber spine was tested too.Subjects above were compared among the four groups.The correlation of BMD with other bone metabolic indicators and HOMA-IR was also investigated in MS with osteoporosis group.Results The incidence of abnormal bone metabolism in MS group was 57.3％ (63/110),while in non-MS group was 11.1％ (4/36),and there was significant difference between two groups (x2 =6.55,P ＜ 0.01).Compared with non-MS group,MS group,MS with osteoporosis group and MS with decreased bone mass group had significant higher BMI,waist circumference,SBP,D BP,FPG,2 h PG,TC,TG,LDL-C,FINS,HOMA-IR(P ＜ 0.01 or ＜ 0.05) and lower HDL-C (P ＜ 0.01).Compared with non-MS group,MS group,MS with osteoporosis group and MS with decreased bone mass group had lower PINP,25-(OH)D3,osteocalcin and BMD (P ＜0.05 or ＜0.01) and higher PTH,urinary calcium/Cr,U-CTX/Cr(P ＜ 0.05 or ＜ 0.01).There was no significant difference in serum calcium,phosphate and alkaline phosphatase among four groups (P ＞ 0.05).BMD in MS with osteoporosis group was positively correlated with osteocalcin and 25-(OH)D3 (P ＜ 0.05),negatively correlated with PTH,U-CTX/Cr,urinary calcium/Cr and HOMA-IR (P ＜ 0.05).Conclsion Loss of bone mass and osteoporosis in middle-aged male patients with MS is due to decreased bone formation and increased bone absorption,which is closely related to insulin resistance.