Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Objective To observe the impairment effect of retinol binding protein 4(RBP4) on neurocognitive function in diabetic nephropathy(DN) patients with silent cerebral infarction(SCI) and to explore its mechanism.Methods Sixty patients with newly diagnosed DN and 30 healthy volunteers were selected as the study subjects and the DN cases were divided into the complicating SCI group(SCI,n=30) and non-complicating SCI group(NSCI,n=30) according to the imaging results.The degrees of neurological function deficit and Montreal cognitive assessment(MoCA) were evaluated.Serum RBP4 level was determined by ELISA and expressions of Lp-PLA2 and C-X-C chemokine receptor type 4(CXCR4) were determined by Western blot.Results Compared with the NSCI group,the neurocognitive function in the SCI group was subsided,the expression levels of RBP4,Lp-PLA2 and CXCR4 were increased(P＜0.05).The RBP4 level was positively correlated with the neurocognitive function impairment in SCI patients,moreover,there existed a regression correlation between them.Conclusion Serum RBP4 may serve as the predictive factor of DN complicating SCI and is positively correlated with neurocognitive dysfunction.Lp-PLA2/CXCR4 pathway activation may be one of its pathogenesis.

A total of 108 subjects were enrolled in this study, including 21 healthy subjects(control group), 34 non-obese patients with polycystic ovary syndrome [PCOS1 group, body mass index(BMI)<25 kg/m²], 32 obese patients with PCOS(PCOS2 group, BMI≥25 kg/m²), and 21 simple obese patients whose age and BMI matched with PCOS2(OB group). BMI, waist-hip ratio(WHR), fasting plasma glucose(FPG), postprandial 2h plasma glucose(2hPG), HbA_1C, fasting insulin(FINS), postprandial 2h insulin(2hINS), sex hormones, and lipid parameters were determined. The status of insulin resistance was assessed by homeostasis model assessment for insulin resistant index(HOMA-IR)and insulin sensitivity index(ISI). Levels of plasma galectin-3 and interleukin-6(IL-6)were detected by ELISA. The results showed that the plasma level of galectin-3 was significantly higher in PCOS group than those in control and OB groups(all P<0.05). Moreover, the level of galectin-3 was also higher in OB group compared with control group, while galectin-3 level in PCOS2 group was higher than that in PCOS1 group(all P<0.05). After adjusted by age, BMI, and WHR, correlation analysis showed that the level of galectin-3 was positively correlated with FPG, 2hPG, FINS, HOMA-IR, highly-sensitive C-reactive protein, and IL-6, while negatively correlated with ISI. A multiple linear regression analysis revealed that the plasma galectin-3 concentration was independently associated with IL-6, HOMA-IR, and BMI(all P<0.05). These data suggest that plasma galectin-3 is closely associated with glucose metabolism, chronic inflammation, and insulin resistance, which may be involved in the pathogenesis of PCOS. (Chin J Endocrinol Metab, 2018, 34: 578-582)

Objective: To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO. Methods: Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×10⁹/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×10⁹/L. Results: A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×10⁹/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×10⁹/L) at 4^th week, 8^th week and 12^th week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×10⁹/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild. Conclusion Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.

Objective To investigate the effects of miR-335-5p on the proliferation and apoptosis of osteoblasts which were exposed to high glucose condition, and explore its possible molecular mechanisms. Methods MC3T3-E1 osteoblasts were divided into four groups:control group(5. 5 mmol/L glucose), high glucose group(HG group, 22. 0 mmol/L glucose), agomir-335-5p group(transfected with agomir-335-5p and exposed to 22. 0 mmol/L glucose) , and agomir negative control group( agomir NC group, transfected with agomir negative control and exposed to 22. 0 mmol/L glucose), cultured for 7 days. Cell proliferaton, cell apoptosis, expressions of miR-335-5p and dickkopfhomolog1(DKK1)mRNA,proteinlevelsofDKK1andcysteinylaspartate-specificproteinase-3(caspase-3) were detected using MTT, flow cytometry, quantitative realtime PCR and western blot, respectively. Results Compared with control group, the expression of miR-335-5p mRNA and cell proliferation in HG group were significantly decreased(P<0. 05), while cell apoptosis and the protein levels of DKK1 and caspase-3 were increased significantly(P<0. 05), the expression of DKK1 mRNA did not change (P>0. 05). The miR-335-5p mRNA expression and cell proliferation in agomir-335-5p group were higher than those in HG group and agomir NC group(P<0. 05). However, Cell apoptosis and the protein levels of DKK1 and caspase-3 in agomir-335-5p group were lower than those in HG group(P<0. 05). Conclusion High glucose inhibits the proliferation and induce the apoptosis of MC3T3-E1 osteoblast through decreasing the expression of miR-335-5p and subsequently increasing the DKK1 expression.

Objective To investigate the relationship between serum secreted frizzled-related protein 4 (SFRP4) and the first-phase of glucose-stimulated insulin secretion from pancreatic β cell under different glucose tolerance statuses. Methods Fifty-six patients with newly diagnosed type 2 diabetes mellitus ( T2DM group), 52 patients with impaired glucose tolerance (IGT group), and 42 subjects with normal glucose tolerance (NGT group) underwent intravenous glucose tolerance test. Fasting serum SFRP4 and interleukin ( IL)-1β were assayed by ELISA. Acute insulin response ( AIR), the area under the curve of the first-phase (0-10 min) insulin secretion (AUC), glucose disposition index(GDI), homeostasis model assessment for β cell function index(HOMA-β), and insulin resistance index(HOMA-IR) were calculated. Results (1) The levels of SFRP4 and IL-1β in T2DM group and IGT group were significantly higher than that in NGT group [(184. 38 ± 61. 34 or 141. 64 ± 40. 46 or 95. 46 ± 20. 13)ng/ ml, P<0. 01]. AIR, AUC, and GDI in T2DM group and IGT group were significantly lower than those in NGT group(P<0. 01), and these results were more significantly reduced in T2DM group compared with those in IGT group. (2) SFRP4 was negatively correlated with AIR, AUC, GDI, HOMA-β (P<0. 01), and positively correlated with fasting plasma glucose, 2 h plasma glucose after glucose loading, HbA1C , IL-1β, and high sensitive C-reactive protein(P<0. 01). (3) Multiple stepwise regression analysis showed that AUC, HOMA-IR, and serum IL-1β level were independently associated with SFRP4. Conclusion The concentration of serum SFRP4 is closely correlated with the glycolipid metabolic disorder, the first-phase of glucose-stimulated insulin secretion, and chronic low-grade inflammation. SFRP4 may be involved in the mechanism of β cell dysfunction in type 2 diabetes mellitus.

Objective To investigate the effects of Yindan Xinnaotong Soft Capsule on oxidative stress and vascular endothe‐lial function in the patients with type 2 diabetes mellitus(T2DM ) .Methods A total of 86 patients with T2DM were randomly di‐vided into the routine glucose‐reducing group(routine group ,40 cases) and the Yindan Xinnaotong Soft Capsule group(Yindan Xin‐naotong group ,46 cases) .On the basis of diet control and exercise ,the routine group was given the glucose‐reducing therapy for blood glucose reaching the standard for 12 successive weeks ,while on the basis of blood glucose reaching the standard by the rou‐tine therapy ,the Yindan Xinnaotong group was added with Yindan Xinnaotong Soft Capsule ,1 .2 g per time ,3 times daily for 12 successive weeks .The changes of blood lipids ,MDA ,SOD ,NO and ET were determined before treatment and after 12‐week treat‐ment .The flow mediated endothelium‐dependent diastolic function (FMD) and non‐flow mediated endothelium‐dependent diastolic function (NMD) in brachial artery were simultaneously detected using ultrasonography .Results After 12 weeks of treatment ,the levels of TC ,TG ,LDL‐C ,MDA and ET in the two group were obviously decreased compared with before treatment ,the levels of HDL‐C ,SOD ,NO and FMD in both groups were increased (P<0 .05);moreover the above indexes after treatment in the Yindan Xinnaotong group had significant changes compared with the routine group (P<0 .05) .Conclusion Yindan Xinnaotong Soft Cap‐sule can down‐regulate oxidative stress and regulate the lipid metabolic abnormality and obviously improve the injured vascular en‐dothelial function in T2DM .

Recent studies have shown that brain natriuretic peptide ( BNP ) may be the link between cardiovascular disease and metabolic system. The role for BNP in metabolic pathways has already been the subject of intense interest. This article reviews the evidence of the linkage between BNP and metabolic system.

To investigate the relationships among plasma secreted frizzled-related protein ( sfrp) 5 level and body fat parameters, glucolipid metabolism, insulin resistance index, and inflammation. 89 subjects with normal glucose tolerance(NGT) and 87 patients with type 2 diabetes mellitus (T2DM) were enrolled and each group was divided into no-obese and obese subgroups. Obesity was defined as body mass index ( BMI)≥25 kg/m2 according to the World Health Organization -Western Pacific Region diagnostic criteria ( 2000 ) . Body fat parameters were measured and BMI, waist-hip ratio were evaluated, meanwhile, the levels of blood glucose-lipid parameters and fasting insulin were also determined. Insulin resistance index ( IR) was assessed by homeostasis model assessment ( HOMA) . The concentrations of plasma sfrp5 and interleukin 6 were detected by enzyme-linked immunosorbent assay. Plasma sfrp5 level in T2DM group was significantly lower than that in NGT group [(8. 35±3. 38 vs 11. 35±3. 69)ng/ml, P<0. 01]. The levels of plasma sfrp5 in subjects with obesity were also lower than those in subjects with no-obesity in both NGT and T2DM groups [(9. 46±2. 70 vs 13. 12±3. 62)ng/ml and(6. 70±2. 34 vs 10. 12±3. 45) ng/ml, both P<0. 01]. Plasma concentrations of sfrp5 in T2DM-obese group were significantly lower than that in NGT-obese group(P<0. 01). Correlation analysis showed that plasma sfrp5 levels were negatively correlated with waist-hip ratio, HbA1C, fasting insulin, triglycerides, waist circumference, fasting plasma glucose, interleukin 6, natural logarithm of HOMA-IR [ln(HOMA-IR)], and BMI(P<0. 01 or P<0. 05). Multiple linear regression showed that ln(HOMA-IR), BMI, triglycerides were independent related factors in influencing the levels of plasma sfrp5 (r2=0. 216, 0. 177, 0. 113, all P<0. 05). Plasma sfrp5 levels were decreased in obesity and T2DM subjects and were correlated with body fat disposition, glucose-lipid metabolism, insulin resistance and inflammation. Lack of sfrp5 may contribute to the pathophysiology of obesity and T2DM.