Objective:To explore the effect of health education based on outcome-based concept on self-management ability and glycemic control in hospitalized patients with type 2 diabetes melittus (T2DM).Methods:A total of 103 T2DM patients admitted in the Endocrinology Department of 903 Hospital of PLA from March 2022 to September 2022 were recruited and randomly divided into study group ( n=52) and control group ( n=51). Routine health education was given to all patients, while additional outcome-based health education was provided by diabetes specialist nurses for the study group during hospitalization. At 12 weeks after discharge, the self-management ability and glycemic control were compared between the two groups. Results:At 12 weeks after discharge, patients in the study group had significantly better self-management ability (dietary control: (4.06±0.75) vs. (3.70±0.88), t=2.50, regular exercise: (3.88±0.62) vs. (3.52±0.94), t=2.30, medical compliance: (4.47±0.51) vs. (4.12±0.64), t=3.14, self blood glucose monitoring: (3.43±0.87) vs. (2.94±0.95), t=2.71, foot care: (3.56±0.57) vs. (2.77±0.87), t=5.42, and management of hyper or hypoglycemia:(3.65±0.72) vs. (3.24±0.96), t=2.48); glycemic control (fasting blood glucose: (6.31±0.90) vs. (6.88±1.37)mmol/L, t=-2.46, 2-h postprandial blood glucose: (8.39±1.64) vs. (9.27±2.50)mmol/L, t=-2.11, HbA1c: (6.76±0.98)% vs. (7.17±0.93)%, t=-2.22). The control rate of HbA1c in the study group was significantly higher and the incidence of hypoglycemia was significantly lower than those in the control group (78.8%(41/52) vs. 58.8%(30/51), χ 2=4.82 and 11.5%(6/52) vs. 29.4%(15/51), χ 2=5.07, respectively). Conclusions:The outcome-based health education can effectively enhance self-management ability and glycemic control in hospitalized type 2 diabetic patients.

Objective To investigate the correlation between sex hormone-binding globulin(SHBG)and lipid metabolism and visceral fat area(VFA)in male adults with different glucose tolerance.Methods A total of 473 male subjects were enrolled from the outpatient clinic and ward in PLA NO.903 Hospital from January 2018 to December 2020.All the subjects were divided into three groups according to OGTT results:normal glucose tolerance group(NGT,n=179),impaired glucose regulation group(IGR,n=90)and newly diagnosed type 2 diabetes mellitus group(T2DM,n=204).Serum SHBG level,abdominal visceral fat area(VFA)and biochemical indexes were compared among the three groups.Results Compared with NGT group,WC,WHR,BMI,HbA1c,FPG,2 hPG,2 hIns,TG and VFA were increased(P＜0.05),while SHBG was decreased(P＜0.05)in IGR group.WC,SBP,DBP,HbA1c,FPG,2 hPG,2 hIns,HOMA-IR,TG,FFA,VFA and VFA/SFA were increased,while HOMA-β,SHBG were decreased(P＜0.05)in T2DM group.Compared with IGR group,SBP,HbA1c,FPG,2 hPG,2 hIns and HOMA-IR were increased,HOMA-β was decreased in T2DM group(P＜0.05).Pearson correlation analysis showed that SHBG was positively correlated with HDL-C(P＜0.01),but was negatively correlated with WC,WHR,BMI,2 hIns,SUA,TG,VFA and SFA(P＜0.05 or P＜0.01).Multivariable linear regression analysis showed that HDL-C,TG and VFA were the influencing factors for SHBG.Conclusion Serum SHBG is closely related to abdominal obesity and lipid metabolism.Increasing the level of SHBG can reduce visceral fat accumulation and improve IR.

ObjectiveTo investigate the changes of intestinal microbiota in type 2 diabetic diarrhea （T2DD） patients with dampness-heat syndrome and spleen-kidney deficiency syndrome. MethodT2DD patients who were admitted to the Department of Endocrinology Ⅰ of the Affiliated Hospital of Shaanxi University of Chinese Medicine from March 2020 to May 2021 were selected， including 14 patients with type 2 diabetes mellitus （T2DM）， 12 T2DD patients with dampness-heat syndrome， and 13 T2DD patients with spleen-kidney deficiency syndrome. Twelve healthy subjects receiving medical examination were selected as control group. Their body mass index （BMI）， fasting plasma glucose （FPG）， 2 h postprandial blood glucose （2 h PBG） and glycosylated hemoglobin （HbA1c） were compared. Fecal samples were collected for DNA extraction to build a database. High-throughput 16S rDNA sequencing was used to compare the composition of intestinal microbiota and the differential bacteria among the four groups. ResultCompared with the conditions in control group， the levels of FPG， 2 h PBG and HbA1c in the other groups were increased （P<0.05）. Alpha diversity showed no significant difference in species richness， evenness and diversity of intestinal microbiota among the groups. Beta diversity indicated that intestinal microbiota tended to be consistent in each group， and there was no marked difference between groups. The top 5 phylum by relative abundance were Bacteroidetes，Proteobacteria， Firmicutes， Actinobacteria， and Fusobacteria， among which，Bacteroidetes， Proteobacteria and Firmicutes were dominant. Compared with the control group， the three diabetic groups had elevated relative abundance of Bacteroidetes while decreased relative abundance of Firmicutes. The relative abundance of Actinomycetes in spleen-kidney deficiency T2DD group was significantly higher than that in the other groups， and the relative abundance of Firmicutes and Fusobacteria in the dampness-heat T2DD group was significantly lower than that in the other groups. At the genus level， the top 10 bacteria by relative abundance were Phocaeicola， Bacteroides， Pseudescherichia， Prevotella， Bifidobacterium， Faecalibacterium， Fusobacterium， Roseburia， Citrobacter， and Cetobacterium. LEfSe analysis revealed that the relative abundance of Prevotella， Mediterraneibacter， Parabacteroides， and Fusicatenibacter in diabetic patients was remarkably higher than that in healthy patients. Bacteroides and Sutterella might be the characteristic microbiota of T2DD patients with dampness-heat syndrome， while Faecalibacterium， Limosilactobacillus， Eubacterium， Gemmiger， Enterocloster， Alistipes， Parasutterella and Oscillibacter might be the characteristic microbiota of T2DD patients with spleen-kidney deficiency syndrome. ConclusionBacteroides and Parasutterella might be the characteristic microbiota of T2DD patients with dampness-heat syndrome and spleen-kidney deficiency syndrome， respectively. This paper provided reference for studying the mechanism， diagnosis and treatment of modern traditional Chinese medicine for T2DD of dampness-heat type and spleen-kidney deficiency type.

Objective:To investigate the effect of high glucose on the release of interleukin (IL)-1β and IL-18 in placental trophoblast by activating NLRP3 inflammasome.Methods:Gestational diabetes mellitus(GDM) placentas and control placentas were collected and the expression levels of NLRP3 and Caspase-1 were determined. Human placental trophoblast HTR-8/SVneo were cultured and divided into control group(5.5 mmol/L glucose), high glucose group(25 mmol/L glucose), DMSO+ high glucose group, and Ac-YVAD-cmk(NLRP3 inflammasome inhibitor)+ high glucose group. The expression levels of NLRP3 and Caspase-1 in cells as well as the contents of IL-1β and IL-18 in the medium were determined.Results:The expression levels of NLRP3 and Caspase-1 in GDM placenta were higher than those in control placenta( P<0.05) and positively correlated with homeostasis model assessment of insulin resistant index(HOMA-IR) and fasting insulin. The expression levels of NLRP3 and Caspase-1 in HTR-8/SVneo cells and the secretion levels of IL-1β and IL-18 in high glucose group were higher than those in control group( P<0.05). Ac-YVAD-cmk significantly suppressed high glucose-stimulated IL-1β and IL-18 secretion( P<0.05). Conclusion:High glucose promotes the release of IL-1β and IL-18 from placental trophoblast via activating NLRP3 inflammasome.

Objective:To assess the implementation of injection-related risk management based on WeChat platform for type 2 diabetic patients with the insulin self-injection.Methods:A total of 124 diabetic patients, who would receive insulin therapy by self-injection at home after discharge from the PLA 903 hospital during April 2017 to July 2018, were divided into the control group( n=62)and the study group( n=62). All patients were given routine education on insulin injection during the hospitalization,while the study group( n=62)received additional video and text education based on WeChat platform after discharge. The skill of self-injection and the status of blood glucose control were evaluated in both groups 4 weeks and 8 weeks after discharge, respectively. Results:The insulin injection skill, including skin disinfection [36(58%) vs. 11(18%),χ 2=21.42, P<0.01], exhaust before injection [62(100%) vs. 51(82%),χ 2=12.07, P<0.01], stay 10s after injection [60 (97%) vs. 47(76%),χ 2=11.52, P<0.01], disposal of used needle[49(79%) vs. 18(29%),χ 2=31.20, P<0.01], rotation of injection site [48(77%) vs. 35(56%),χ 2=6.16, P=0.01], insulin storage [62(100%) vs. 57(92%),χ 2=5.21, P=0.02], and the ability of correctly dealing with hypoglycemia [52(84%) vs. 38(61%),χ 2=7.94, P=0.01] in the study group were significantly better than those in the control group after 4 weeks of injection-related risk management. The fasting plasma glucose [(6.41±0.76) vs.(7.19±0.81)mmol/L, t=5.61, P<0.01], glycosylated hemoglobin A1c [(6.71±0.64)% vs. (7.37±0.78)%, t=5.18, P<0.01], incidence of hypoglycemia [6(10%) vs. 15(24%),χ 2=4.64, P=0.03] in the study group were significantly lower than those in the control group after 12 weeks of the management. Conclusion:The risk management based on WeChat platform can improve insulin self-injection skill and the ability of dealing with hypoglycemia,also promote effective blood glucose control for diabetes patients.

Objective:To compare the clinical outcomes of one and two blastocysts in the freeze-thaw transplantation cycle.Methods:Totally 3 675 cycles of frozen thawed blastocyst transplantation in Reproductive Medical Center of the Second Nanning People′s Hospital from January 2012 to December 2016 were analyzed retrospectively. According to the quantity and quality of transferred blastocysts, all the patient were divided into two groups: (1) one embryo group, including the single excellent group (one high quality blastocyst) and the single non excellent group (one non high quality blastocyst); (2) two embryo groups, including the double excellent group (two high quality blastocysts), the one excellent and one non excellent group (one high quality blastocyst+one non high quality blastocyst), and the two non excellent group (two non high quality blastocysts were transplanted). Then the patients were divided into subgroups according to their ages: less than 35 years old, 35-40 years old and over 40 years old. On this basis, the implantation rate, clinical pregnancy rate, multiple birth rate and live birth rate were compared.Results:(1) The implantation rate, clinical pregnancy rate, multiple birth rate, preterm birth rate and live birth rate were all significantly increased, while the abortion rate was significantly reduced in the double blastocyst group (all P<0.05). (2) In the group of<35 years old, the rates of multiple birth and preterm birth in the double blastocyst group were significantly higher than those in the single optimal group ( P<0.01). (3) In the 35-40 years old group, the clinical pregnancy rate, multiple birth rate and live birth rate of the double excellent group were significantly higher than those of the single excellent group ( P<0.01); while the clinical pregnancy rate and live birth rate of the one excellent and one non excellent group and the double non excellent group were not significantly different from those of the single excellent group ( P>0.05), but the multiple birth rate and preterm birth rate were significantly increased ( P<0.01). The clinical pregnancy rate, live birth rate and multiple birth rate of double non optimal group were significantly higher than those of single non optimal group ( P<0.01). (4) In the group>40 years old, there were no significant differences in clinical pregnancy rate and live birth rate between the two groups ( P>0.05). There were no significant differences in implantation rate, clinical pregnancy rate and live birth rate between double non optimal group and single non optimal group ( P>0.05). Conclusion:No matter the age of the patients, if the couple have high quality blastocysts, we should give priority to single high quality blastocyst transplantation; even if they have no high quality blastocysts, we should also consider single blastocyst transplantation, in order to reduce the risk of multiple pregnancy and improve the cumulative live birth rate, so as to improve the pregnancy outcome.

The clinical data of 96 patients with type 2 diabetes mellitus (T2DM) treated in Department of endocrinology of our hospital from January 2016 to December 2017 were retrospectively analyzed. All patients had been treated with metformin ≥1 000 mg combined with sulfonylureas for>12 weeks and their glycosylated hemoglobin (HbA1c) was>7.5%. On the basis of the original scheme, 57 patients received oral sitagliptin (100 mg q.d, sitagliptin group) and 39 patients received insulin glargine injection (insulin group) for 26 weeks. The blood lipid, liver and kidney function were examined before and after treatment. The abdominal visceral fat area (VFA) was measured by CT scan. Results showed that the fasting plasma glucose (FPG) , 2-hour postprandial blood glucose (2 hPG) and HbA1c were significantly lower than baseline levels in both groups(P<0.05). The decrease of VFA in sitagliptin and insulin groups was by 9.6 (1.4,19.6)cm² and by 8.3(-2.2,26.8) cm², respectively; there was significant difference in variation of VFA before and after treatment between the two groups (P<0.05). There was no significant difference in blood pressure, liver function (ALT, AST) and estimated glomerular filtration rate (eGFR) before and after treatment in the sitagliptin group (P>0.05). Additional sitagliptin administration can effectively and safely reduce HbA1c and decrease the abdominal visceral fat content in T2DM patients who failed to metformin and sulfonylureas combined therapy.

Eighty patients with hyperthyroidism treated in PLA 903 Hospital from February 2016 to May 2017 were randomly divided into two groups with 40 cases in each group.Patients in control group received routine outpatient education and those in study group received regular formatted mobile short message during follow-up in addition to routine education.The knowledge of disease,the compliance and satisfaction of treatment were assessed.After 12 weeks of follow-up,the TSH level was higher [0.430(0.050,2.806) vs.0.210(0.003,1.098) mU/L,Z=-8.07,P＜0.01],FT3 [(3.24± 1.18) vs.(4.18±2.07)ng/L,t=-2.49,P＜ 0.05] and FT4 levels [(12.43±6.82) vs.(19.58±19.06) ng/L,t=-2.26,P＜0.05] were lower in study group than those in control group.The scores of disease knowledge (6.12± 1.77 vs.5.25±1.79,t=4.67,P＜0.05),the Morisky scores of medication compliance (3.77±0.47 vs.3.37±0.73,t=8.22,P＜0.01),the rates of compliance for returning (85％ vs.65％,x2=4.27,P＜0.05) and the satisfaction rates with treatments (93％ vs.75％,x2=3.30,P＜0.05) in the study group were significantly higher than those in the control group.The score of disease knowledge in study group increased from 4.32± 1.55 before treatment to 6.12± 1.77 after 12 weeks of follow-up (t=22.65,P＜0.01).The results indicate that the health education plus regular formatted text message during follow-up can effectively improve the disease knowledge score,the compliance and satisfaction with treatment in patients with hyperthyroidism.

Objective To study the effect of hydrogen sulfide on the production of soluble fms-like tyrosine kinase 1 (sFlt-1) through a distintegrin and metalloproteinase 17 (ADAM17) in adipocytes. Methods 3T3-L1 cells were cultured and induced to differentiate into adipocytes, then treated with different doses of sodium hydrogen sulfide (NaHS), L-cysteine or transfected with cystathionine-γ-lyase ( CSE) siRNA, ADAM17 siRNA or treated with ADAM17 inhibitor, monoclonal antibody. 24 hours after treatment, the expression of ADAM17, CSE, and the production of sFlt-1 were determined. Results After the treatment of 10, 25, 50 nmol/L NaHS or 0. 5, 1. 0, 2. 0 μmol/L L-cysteine, the expression of ADAM17 and the production of sFlt-1 in adipocytes were significantly decreased, the higher dose of L-cysteine and sFlt-1, the lower expression of ADAM17 and the production of sFlt-1; the effect of 2.0 μmol/L L-cysteine decreasing the expression of ADAM17 and the production of sFlt-1 were reversed by transfection of CSE siRNA; after the transfection of ADAM17 siRNA and treatment of ADAM17 inhibitor or monoclonal antibody, the production of sFlt-1 in adipocytes were significantly decreased. Conclusion Hydrogen sulfide can reduce the production of sFlt-1 in adipocytes by downregulating the expression of ADAM17.

Objective To investigate the effect of hydrogen sulfide′s donor NaHS on the secretion of interleukin (IL)-1β and IL-18 in adipocytes and its mechanism.Methods 3T3-L1 cells were induced to differentiate into adipocytes and incubated with various concentrations of NaHS or 10 μg/ml caspase-1 inhibitor Ac-YVAD-CMK for 24 hours.The expressions of NLRP3(NLR family, pyrin domain containing 3), ASC(apoptosis associated speck-like protein containing CARD domain), caspase-1, IL-1β, and IL-18 in adipocytes, as well as the content of IL-1 and IL-18 in culture medium were determined.Results 10, 25, and 50 nmol/L NaHS significantly decreased NLRP3, ASC, and cleaved-caspase-1 protein expressions in adipocytes, as well as IL-1β and IL-18 contents in culture medium in a dose-dependent manner.The mature-IL-1β/pro-IL-1β, mature-IL-18/pro-IL-18 ratios in adipocytes and IL-1β and IL-18 contents in culture medium were also reduced by 10μg/ml Ac-YVAD-CMK.Conclusion Donor of hydrogen sulfide NaHS inhibits the maturation and secretion of IL-1β and IL-18 in adipocytes through downregulating the expression of NLRP3 inflammasome.