Trimethylamine N-oxide (TMAO) is an intestinal flora metabolite produced in the liver by the oxidation of trimethylamine (TMA) by hepatic enzymes. Recently, it has been found that plasma TMAO levels play an important role in the development and progression of osteoporosis. This review has presented the physiological functions and metabolic processes of TMAO, and its effects on the development and progression of osteoporosis through oxidative stress and inflammation. Plasma TMAO levels are influenced by diet as well as medications, which provides a new perspective and target for the treatment and prevention of osteoporosis.

Sarcopenia is a disease characterized by a decrease in muscle mass and function that can induce adverse events such as falls, weakness, and death. The latest research shows that the use of many hypoglycemic drugs is associated with sarcopenia. Different types of hypoglycemic drugs may have different effects and mechanisms for the quality and function of skeletal muscle. In this paper, we review the research progress of the relationship between hypoglycemic drugs and sarcopenia and the molecular mechanism in recent years to provide a reference for the diagnosis and treatment prevention of sarcopenia in clinical areas.

Objective:To investigate the application of the decision-oriented context-input-process-product (CIPP) model combined with integrated teaching in standardized training of medical oncology.Methods:A total of 98 standardized training residents who participated in standardized training in Department of Oncology, Jiangsu Cancer Hospital, were enrolled as subjects, and they were divided into control group and observation group using a simple random number table, with 49 residents in each group. The residents in the control group received routine teaching, and those in the observation group received CIPP model combined with integrated teaching. The two groups were compared in terms of department examination score and assessment of subjective learning effect, and the observation group was assessed in terms of critical thinking ability before and after training. SPSS 22.0 was used for the t-test. Results:Compared with the control group, the observation group had significant increases in theoretical examination score ( t=2.95, P=0.004), practical operation score ( t=17.04, P<0.001), and total score ( t=3.55, P=0.001). After training, the observation group had significant increases in the scores of each dimension of critical thinking ability and the total score of critical thinking ability ( t=2.89, 3.55, 3.37, 3.20, 3.13, 2.67, 3.06, 3.13; P=0.005, 0.001, 0.001, 0.002, 0.002, 0.009, 0.003, 0.002). The observation group had significantly higher assessment scores of subjective learning effect than the control group ( t=3.46, 3.56, 2.83, 2.85, 2.57, 3.07; P=0.001, 0.001, 0.006, 0.005, 0.012, 0.003). Conclusion:The CIPP model combined with integrated teaching can improve the department examination score and critical thinking ability of standardized training residents in medical oncology, with good assessment results of subjective learning effect.

Objective:To examine the relationship between pre-pregnancy BMI, gestational diabetes (GDM) and different indicators of childhood obesity at the age of 4.Methods:Based on Ma’anshan Birth Cohort Study, singleton children who were born in Ma’anshan of Anhui province from October 2013 to April 2015, were followed for 4 years, consecutively. During the first questionnaire survey, data including pre-pregnancy weight, height and socio-demography were collected. During 24-28 week of gestation, 75 g oral glucose tolerance test was conducted for them. Childhood height, weight, waist circumference and body composition were measured at the age of 4. Comparisons between groups were performed using chi-square test, analysis of variance or t-test. The relationship between pre-pregnancy overweight/obesity, GDM and childhood obesity-related characteristics were analyzed by logistic regression model and generalized linear model analysis. Results:The prevalence rates of overweight and obesity in children at the age of 4 were 13.08% and 6.03%, respectively. After adjustment for characteristics related to mothers and their children, significantly increased risk of obesity ( OR=3.27, 95% CI: 2.15-4.98), larger waist circumference ( OR=2.32, 95% CI: 1.72-3.14) and higher waist-to-weight ratio ( OR=2.29, 95% CI: 1.73-3.02) were seen in the offspring of women with pre-pregnancy overweight/obesity. Body composition (skeletal muscle, body fat, body fat percentage) of the offspring were strongly correlated with pre-pregnancy overweight/obesity of the mothers ( P<0.05). Maternal GDM was associated with higher risk of childhood obesity ( OR=1.78, 95% CI: 1.14-2.79), on mothers without GDM during pregnancy. However, neither larger waist circumference, or higher waist-to-weight ratio seemed to increase the risk. Moreover, maternal GDM was not associated with body composition measures (skeletal muscle, body fat, body fat percentage). Conclusion:Pre-pregnancy BMI and maternal GDM were independent risk factors for obesity in 4-year-old children, and pre-pregnancy BMI was correlated with various indicators of body composition in children.

Objective To investigate the effects of Metformin on serum proprotein convertase subtilisin/kexin type 9(PCSK9)level in patients with type 2 diabetes(T2DM). Methods 48 healthy people with normal glucose tolerance were selected as the controls (NGT group). 93 newly diagnosed T2DM were randomized to Metformin treated group (Met,n= 47 )and Glipizide treated group (Gli,n=46).Serum PCSK9 was measured by ELISA in all participants. After treatment,the changes of serum PCSK9 were observed in Met group and Gli group. Results Serum PCSK9 levels in Met group and Gli group were higher than NGT group(P<0. 01). PCSK9 level was positively correlated with FPG,HbA1 c, HOMA-IR,FIns,TC,LDL-C,TG,hsC-RP,TNF-αand BMI (r= 0. 578,0. 638,0. 556,0. 610,0. 578, 0. 592,0. 589,0. 638,0. 561,0. 552;P<0. 05 or P<0. 01),and negatively correlated with HDL-C(r=-0. 614,P<0. 01). The levels of PCSK9 significantly decreased after treatment with Metformin(P<0. 05). PCSK9 levels had no significant differences before and after treatment with Glipizide. Multiple regression analysis showed that TNF-αand HOMA-IR were independent related factors of PCSK9. Conclusion T2DM patients have high levels of serum PCSK9 which can be decreased by Metformin.

Objective To explore the effect and mechanism of curcumin on rat cerebral ischemia reperfusion injury.Methods The rat model of cerebral ischemia reperfusion injury was constructed by the suture-occluded method.The effects of curcumin on cerebral infarction range,cerebral water content,neurological symptoms,cerebral histopathological morphology and expressions of PI3K,AKT,p-AKT,m-TOR,MDA,CAT,GPX,SOD,Bcl-2,Bax,Caspase-3 and Cleavage-Caspase-3 were evaluated.Results Cur-cumin had the protective effect on cerebral ischemia reperfusion injury,could alleviate the neurological symptoms,decreased the cer-ebral tissue pathological morphological changes and cerebral water content,in addition,which could alleviate the expressions of MDA,Bax,Cleavage-Caspase-3,IL-6,MCP-1 and TNF-αand increased the expressions of PI3K,p-AKT,mTOR,Bcl-2,Caspase-3, CAT,GPX and SOD.Conclusion The curcumin pretreatment has the significantly protective effect on cerebral ischemia-reperfusion injury,which may be associated with activating PI3K/AKT/mTOR signal pathway,while suppressing inflammation,apoptosis and oxidative stress.

Objective To explore the association of serum Irisin with diabetic nephropathy(DN) in patients with type 2 dia‐betes mellitus(T2DM) .Methods Totally 40 cases of patients with newly diagnosed T2DM(SDM group) ,41 cases of patients with early diabetic nephropathy(EDN group) ,and 42 cases of patients with clinical diabetic nephropathy(CDN group) were selected ,an‐other 40 healthy individuals with normal glucose tolerance were selected as the controls(NC group) .Serum Irisin was measured by using ELISA method .Results (1) The serum Irisin levels of four groups from high to low were:NC group(320 .48 ± 107 .03)ng/mL ,SDM group(291 .53 ± 101 .01)ng/mL ,EDN group(278 .54 ± 93 .48)ng/mL ,CDN group(209 .12 ± 88 .53)ng/mL ,and the difference was statistically significant(P<0 .05) .(2)The correlation analysis showed that Irisin level was negatively correlated with insulin resistance index (HOMA‐IR) ,fasting insulin (FINS) ,FPG ,HbA1c ,Scr ,BUN ,TNF‐αand UAlb/Cr(r= -0 .592 ,-0 .610 ,-0 .614 ,-0 .638 ,-0 .538 ,-0 .552 ,-0 .589 ,-0 .561 ,P<0 .05) ,and positively correlated with superoxide dismutase (SOD) and HDL(r=0 .578 ,0 .556 ,P<0 .05) .(3)The regression analysis showed that UAlb/Cr and HOMA‐IR were the independent influen‐cing factors of Irisin .Conclusion The level of serum Irisin in DN patients is decreased ,and the level of Irisin may be correlated with the severity of DN .

Objective To investigate the changes of serum stromal cell‐derived factor‐1α (SDF‐1α) in patients with diabetic peripheral neuropathy (DPN) and the influence of mouse never growth factor (MNGF) on the levels of serum SDF‐1α. Methods 180 patients with type 2 diabetes (T2DM ) were divided into T2DM with DPN (DPN group ,n=92) and T2DM without DPN (T2DM group ,n=88). 90 healthy people were select as normal control (NC group). DPN group was divided into 47 cases of MNGF treatment (A) subgroup and 45 cases of basic treatment (B) subgroup. The levels of serum SDF‐1αwere measured using ELISA method. The relationships between the levels of serum SDF‐1αand SOD ,TGF‐β1 , hsC‐RP ,and GAP‐43 were analyzed. After treatment ,the levels of serum SDF‐1α in A and B subgroups were compared. Results Compared with NC group [(0.91 ± 0.37)μg/L] ,the levels of serum SDF‐1αin T2DM and DPN group were higher [(2.58 ± 0.58) μg/L and(1.71 ± 0.43)μg/L ,respectively ,P<0.05 or P<0.01]. The levels of SDF‐1αwere positively correlated with FPG ,HbA1 c ,TGF‐β1 and hsC‐RP ,and negatively correlated with SOD in T2DM group. The levels of SDF‐1αwere positively correlated with TG and TGF‐β1 ,and negatively correlated with course of disease ,FPG ,HbA1 c ,SOD ,hsC‐RP ,GAP‐43 , MMCV ,PMCV ,MSCV and PSCV in DPN group. SDF‐1α levels were significantly increased after treatment with MNGF in subgroup A [(1.75 ± 0.39) vs (2.09 ± 0.45)μg/L ,P<0.05]. There were no significant difference of SDF‐1αlevels after treatment in subgroup B [(1.67 ± 0.48) vs (1.71 ± 0.51)μg/L , P>0.05] .Multiple stepwise regression analysis showed that HbA1c ,hsC‐RP and PSCV were the independent factors related with the levels of SDF‐1αin DPN patients. Conclusion The levels of serum SDF‐1αin DPN patients are lower than in T2DM patients without DPN. MNGF may increase the level of serum SDF‐1α.

Objective To explore the level of angiopoietin‐like protein 4 (ANGPTL4) in patients with early chronic kidney disease (CKD ) in diabetes and the influence of pioglitazone on the level. Methods 92healthypeoplewithnormalglucosetolerancewereselectedasthecontrols(NCgroup).89 newly diagnosed T2DM were selected (T2DM group ). 90 cases of CKD group were divided into pioglitazone (PGZ) and glimepiride (GLI) treated subgroups ,45 cases in each subgroup. After treatment , serum ANGPTL4 levels were observed in CKD group. Results There were significant differences in serum ANGPTL4 levels among NC ,T2DM and CKD groups [(34.8 ± 4.75) vs (31.1 ± 3.65) vs (27.1 ± 3.52)ng/ml ,P<0.05 or P<0.01]. ANGPTL4 level was positively correlated with SOD ,TG (r=0.635 , 0.526 ,P< 0.05 or P< 0.01) ,and negatively correlated with BMI ,FPG ,HbA1c ,hsC‐RP ,UAlb/Cr , VEGF ,FIns ,HOMA‐IR (r= -0.502 ,-0.624 ,-0.542 ,-0.520 ,-0.538 ,-0.566 ,-0.576 ,-0.509 ,P< 0.05 or P < 0.01 ). In PGZ subgroup after treatment ,ANGPTL4 levels were significantly increased and UAlb/Cr significantly decreased [(31.51 ± 3.87 ) vs (27.60 ± 3.58 )ng/ml ,P < 0.05 ;(88.50 ± 8.90 ) vs (116.20 ± 10.30 )mg/24 h ,P < 0.01 ]. In GLI subgroup after treatment ,there were no significant difference in FPG and HbA1 c as compared with PGZ subgroup but ANGPTL4 levels have no significant differences after treatment ,and UAlb/Cr decreased [(27.20 ± 3.54 ) vs (26.60 ± 3.48 )ng/ml ,P > 0.05 ;(99.70 ± 12.80 ) vs (122.40 ± 13.10 )mg/24 h ,P < 0.05]. HbA1 c ,FIns ,UAlb/Cr were the independent related factors influencing ANGPTL4 of CKD patients. Conclusion Serum ANGPTL4 has a lower level in CKD patients. PGZ is effective in treating CKD. This role is associated with the increase of serum ANGPTL4.

Objective To study the epidemiological tendency and influencing factors for major chronic diseases in the elderly in Changsha,and to provide the scientific basis for the prevention and control strategies for the aged people.Methods Multi-stage randomized cluster sampling method was used in selecting 3135 persons aged 65 and over in Changsha.Using unified questionnaire and face to face asking method to investigate the prevalence of chronic diseases and its influencing factors.Results 95.7％ of questionnaires were valid (3000/3135).The total prevalence rate of chronic disease was 86.33％ in patients aged from 65-96 (74.83±6.63) years,with 85.49％ (1332) in males,and 87.23％ (1258) infemales(x2=1.93,P=0.164).Most of them had 1-3 kinds of chronic diseases,in 1 patient with 13 kinds of chronic diseases at the most.The most common chronic diseases among the elderly were hypertension,heart diseases,osteoarthritis,diabetes mellitus,benign prostatic hyperplasia,and fatty liver.Multivariate logistic regression suggested that age,marital status,smoking,quality of sleep were common influencing factors for hypertension,heart diseases and diabetes mellitus.Conclusions The prevalence of chronic diseases is high and the influencing factors are ubiquitous among the elderly in Changsha community.Community health education should be carried out to improve the effect of prevention and control of chronic diseases.