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PurposeThe hemoglobin glycation index (HGI) quantifies the mismatch between glycated hemoglobin A1c and average glycemia among individuals. Currently, it is unknown the potential role of HGI in exhaustively evaluating the progression of glucose metabolism/the risk of developing diabetes mellitus. Therefore, this study aimed to investigate the association between HGI and the risk of incident diabetes.MethodsA total of 7,345 participants aged at least 40 years and without diabetes were divided into three groups according to the tertile of their baseline HGI level and followed for a median of 3.24 years to track new-onset diabetes. Using multivariate Cox regression analyses, we explored the association between the HGI, both categorized and continuous, and incident diabetes.ResultsDuring follow-up, 742 subjects (263 males and 479 females) developed diabetes mellitus. Higher HGI was associated with an increased risk of diabetes, even when adjusted for confounding factors, and every standard deviation increase in HGI was associated with a significant risk increase of 30.6% for diabetes (hazard ratio 1.306, 95% confidence interval 1.232–1.384).ConclusionsParticipants with a higher HGI were at a higher risk of future diabetes, irrespective of their glycemic conditions. Consequently, HGI may be employed to identify individuals at high risk for diabetes.

ObjectiveTo analyze the efficacy and safety of three novel hypoglycemic agents, glucagon-like peptidyl-1 receptor agonists, dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter two inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients with severe chronic kidney disease (CKD) (defined in this study as CKD stage 3 B or above, eGFR< 45 mL/min/1.73 m²) based on important RCTs to date.MethodsWe retrieved studies published before April 15, 2022, from EMBASE, PubMed/MEDLINE, Cochrane Library and included randomized controlled trials in which the participants were patients with T2DM and severe CKD. Frequentist methods were used in the network meta-analysis.ResultsNineteen studies of 17 trials involving 6,607 participants met our inclusion criteria. Compared with placebo and DPP-4i, SGLT2i demonstrated a significantly lower incidence of serious renal-related adverse events or renal death, and the odds ratios (OR) were 0.69 (0.58, 0.81) and 0.63 (0.40, 1.00), respectively. Compared with placebo, SGLT2i significantly reduced the incidence of all-cause death and severe AE; the ORs were 0.72 (0.55, 0.94) and 0.65 (0.47, 0.91), respectively. Compared with placebo, DPP-4i significantly reduced the level of HbA1c, and the difference between mean changes from baseline was -0.36 (-0.63, -0.09).ConclusionsPatients with T2DM complicated by severe CKD may benefit from SGLT2i. SGLT2i can reduce the incidence of serious renal-related AEs or renal death, as well as severe side effects, and has a positive effect on the patient’s renal function and survival, even for only CKD patients can also be considered. GLP-1 RAs can be used as a supplement if blood sugar control is poor. For dialysis patients, DPP-4i can assist blood glucose control, reduce insulin dosage, and reduce the risk of hypoglycemia.Systematic review registrationINPLASY https://inplasy.com/inplasy-2021-12-0106/, identifier INPLASY2021120106.

BackgroundCathepsin K (CTSK) is a protease that degrades type I collagen and extracellular matrix, thereby contributing to bone resorption and tumor invasion. Some pituitary adenomas (PAs) could invade the sphenoid sinus (SS) and cavernous sinus (CS).PurposeThis retrospective cohort study aimed to study the expression of tumoral biomarkers (CTSK, MMP9, MMP2, TIMP2, and PTTG1) and evaluate their clinical significance in non-functioning pituitary adenomas (NFPAs) with different invasion patterns.MethodsWe assessed the expression levels of candidate invasion-specific protein biomarkers CTSK, MMP9, MMP2, TIMP2, and PTTG1 by immunohistochemical staining in paraffin-embedded NFPA tumor tissues. Variations in staining intensity were analyzed in cases with SS and CS invasion and non-invasive NFPAs.ResultsWe found that the levels of CTSK were higher in PA cases with SS invasion than that in PA cases with CS invasion (95.57 ± 31.57 vs. 65.29 ± 29.64, P < 0.001), and the expression of MMP9 and MMP2 was higher in CS-invasive cases than that in SS-invasive cases (145.02 ± 49.25 vs. 111.80 ± 51.37, P = 0.002, and 138.67 ± 52.06 vs. 108.30 ± 41.70, P = 0.002). Multiple Cox regression demonstrated that higher CTSK expression (P=0.011), subtotal resection (PConclusionOur data indicated that CTSK has the potential as a marker for SS invasion of PAs, whereas MMP9 and MMP2 may be markers for CS invasion. And CTSK may play an important role in tumor relapse.

Additional file 1: Table S1. Association of diabetes, elevated fasting glucose, elevated OGTT-2h glucose, and elevated HbA1c with non-fatal CVD events and CVD mortality among current, former, and never smokers. 126,181 participants were included in the analysis. The numbers of missing values are 120 for fasting glucose, 683 for OGTT-2h glucose, and 179 for HbA1c. aAdjusted for age, sex, education attainment (less than high school, high school or further education), family history of diabetes (yes, no), family history of CVD (yes, no), fruits and vegetables intake (

Additional file 1. Table S1. Primer sequences of target genes (mice). Fig. S1. The induction of obese mice. Fig. S2. UC-MSC homing in obese mice. Fig. S3. The effect of UC-MSC infusions on macrophages in the spleen. Fig. S4. The effect of UC-MSC infusions on B10 cells in the spleen. Fig. S5. The effect of UC-MSC infusions on CD4+ T cells and CD8+ T cells in the spleen. Fig. S6. The effect of UC-MSC infusions on monocytes, neutrophils and NK cells in the spleen.

Additional file 1: Table 1. The primers used in quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR)

Purpose The hypertriglyceridemic waist (HTGW) phenotype can predict cardiovascular disease (CVD) risk. Additionally, strong evidence indicates that elevated urinary albumin–creatinine ratio (UACR) is associated with increased prevalence of CVD. However, few studies have explored the association between the HTGW phenotype and UACR. Patients and Methods In this cross-sectional descriptive study, a total of 40,674 subjects (28,562 women and 12,112 men older than 40 years) were recruited from seven different geographic regional centres. The HTGW phenotype was defined as increased triglyceride levels (triglyceride ≥ 1.5 mmol/L for female and ≥2.0 mmol/L for male) and waist circumference (WC; WC ≥ 85 for female and WC ≥ 90 cm for male). Logistic regression analyses were performed to assess the relationship between UACR and the HTGW phenotype. Results Subjects with the HTGW phenotype showed a more significant trend towards increased excretion of UACR [among all subjects, odds ratio (OR) = 1.303, 95% CI: 1.132–1.499, P < 0.001; among men, OR = 1.406, 95% CI: 1.057–1.870, P = 0.019; among women, OR = 1.268, 95% CI: 1.074–1.496, P = 0.005]. Furthermore, the stratified analysis showed that the OR for high-risk significantly increased in individuals in the HTGW group aged below 65 years, with 5.6 ≤ fasting blood glucose < 7.0 or 7.8 ≤ post-load blood glucose 90 mL/min per 1.73 m2. Conclusion This study has advanced the understanding of visceral obesity and our results supported the fact that the HTGW phenotype is associated with elevated UACR excretion among general Chinese adults.

With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. The intended audience comprises Chinese endocrinologists, surgeons, anaesthetists, clinical pharmacists, nurses and professionals involved in perioperative blood glucose management. The guidelines were formulated as follows. First, a multidisciplinary expert group was established to identify and formulate key research questions on topics of priority according to the Population, Intervention, Comparator and Outcomes (PICO) process. We conducted a meta-analysis of available studies using Review Manager version 5.3, as appropriate. We pooled crude estimates as odds ratios with 95% confidence intervals using a random-effects model, and used the Grading of Recommendations Assessment, Development, and Evaluation methods to assess the quality of the retrieved evidence. Finally, 32 recommendations were gathered that covered 11 fields-management and coordination, endocrinologists' consultation, diabetes diagnosis, surgery timing and anaesthesia method, blood glucose target values and monitoring frequency, hypoglycaemia treatment, oral administration of blood glucose lowering drugs, use of insulin, enteral and parenteral nutritional, postoperative treatment and medication and education and training. Twenty-five systematic reviews and meta-analyses were conducted for these guidelines to address the PICO questions. These guidelines are intended to improve perioperative blood glucose management and help doctors in specifying medical diagnosis and treatment, and will be implemented / disseminated extensively in China.

Wanlu Su,1,2,* Jie Wang,1,2,* Yiming Mu1,2 1Medicine School of Nankai University, No. 94 Weijin Road, Tianjin 300071, People’s Republic of China; 2Department of Endocrinology, Chinese People’s Liberation Army General Hospital, Beijing 100853, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yiming MuDepartment of Endocrinology, Chinese People’s Liberation Army General Hospital, No. 28 Fuxing Road, Beijing 100853, People’s Republic of ChinaEmail muyiming@301hospital.com.cnPurpose: The hypertriglyceridemic waist (HTGW) phenotype can predict cardiovascular disease (CVD) risk. Additionally, strong evidence indicates that elevated urinary albumin–creatinine ratio (UACR) is associated with increased prevalence of CVD. However, few studies have explored the association between the HTGW phenotype and UACR.Patients and Methods: In this cross-sectional descriptive study, a total of 40,674 subjects (28,562 women and 12,112 men older than 40 years) were recruited from seven different geographic regional centres. The HTGW phenotype was defined as increased triglyceride levels (triglyceride ≥ 1.5 mmol/L for female and ≥ 2.0 mmol/L for male) and waist circumference (WC; WC ≥ 85 for female and WC ≥ 90 cm for male). Logistic regression analyses were performed to assess the relationship between UACR and the HTGW phenotype.Results: Subjects with the HTGW phenotype showed a more significant trend towards increased excretion of UACR [among all subjects, odds ratio (OR) = 1.303, 95% CI: 1.132– 1.499, P < 0.001; among men, OR = 1.406, 95% CI: 1.057– 1.870, P = 0.019; among women, OR = 1.268, 95% CI: 1.074– 1.496, P = 0.005]. Furthermore, the stratified analysis showed that the OR for high-risk significantly increased in individuals in the HTGW group aged below 65 years, with 5.6 ≤ fasting blood glucose < 7.0 or 7.8 ≤ post-load blood glucose < 11.1 mmol/L, 120 ≤ systolic blood pressure < 140 or 80 ≤ diastolic blood pressure < 90, 24 ≤ body mass index < 28 kg/m2, and estimated globular filtration rate > 90 mL/min per 1.73 m2.Conclusion: This study has advanced the understanding of visceral obesity and our results supported the fact that the HTGW phenotype is associated with elevated UACR excretion among general Chinese adults.Keywords: waist circumference, hypertriglyceridemia, chronic kidney disease, urinary albumin-creatinine ratio

The associations between different combinations of metabolic abnormalities and the risk of all and site-specific cancers remain unclear. We aimed to estimate the association and interplay between serum cholesterol, glycemic status and risk of cancer in the China Cardiometabolic Disease and Cancer Cohort (4C)-Study, a nationwide, multicenter, prospective, population-based study. The investigation was performed in 137,884 participants during 2014-2016. Incident cancer was defined as the first occurrence of any type cancer of all sites during follow-up. After 510,164 person-years of follow-up, 1,710 were detected as incident cancer after exclusion of participants diagnosed as cancer within 6 months from baseline. A relatively low level of LDL cholesterol (

Aims. To investigate the effect of preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgery in diabetic and nondiabetic patients. Methods and Results. The MEDLINE (via PubMed), Cochrane Library, Web of Science, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) databases were used to search the effects of different preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients from inception to December 2018. Two review authors worked in an independent and duplicate manner to select eligible studies, extract data, and assess the risk of bias of the included studies. We used a meta-analysis to synthesize data and analyze subgroups, sensitivity, and publication bias as well as the GRADE methodology if appropriate. The literature search retrieved 886 records initially, and 23 cohort studies were included in the meta-analysis. In this meta-analysis, we found that there was a reduced incidence of surgical site infections (OR=2.94, 95% CI 2.18-3.98), renal failure events (OR=1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR=1.69, 95% CI 1.16-2.47), as well as a shortened hospital stay (MD=1.08, 95% CI 0.46-1.71), in diabetic patients after coronary artery disease surgical treatment with lower preoperative HbA1c levels. For nondiabetic patients, a higher preoperative HbA1c level resulted in an increase in the incidence of mortality (OR=2.23, 95% CI 1.01-4.90) and renal failure (OR=2.33, 95% CI 1.32-4.12). No significant difference was found between higher and lower preoperative HbA1c levels in the incidence of mortality (OR=1.06, 95% CI 0.88-1.26), stroke (OR=1.49, 95% CI 0.94-2.37), or atrial fibrillation (OR=0.94, 95% CI 0.67-1.33); the length of ICU stay (MD=0.20, 95% CI -0.14-0.55); or sepsis incidence (OR=2.49, 95% CI 0.99-6.25) for diabetic patients or for myocardial infarction events (OR=1.32, 95% CI 0.27-6.31) or atrial fibrillation events (OR=0.99, 95% CI 0.74-1.33) for nondiabetic patients. The certainty of evidence was judged to be moderate or low. Conclusion. This meta-analysis showed that higher preoperative HbA1c levels may potentially increase the risk of surgical site infections, renal failure, and myocardial infarction and reduce the length of hospital stay in diabetic subjects after coronary artery disease surgical treatment and increase the risk of mortality and renal failure in nondiabetic patients. However, there was great inconsistency in defining higher preoperative HbA1c levels in the studies included; we still need high-quality RCTs with a sufficiently large sample size to further investigate this issue in the future. This trial is registered with CRD42019121531.

Additional file 1: Table S1. Association of the TyG index, glycemic, lipid parameters as continuous variables with HTN in total subjects. Table S2. Interaction of FBG with TG on hypertension. Table S3. Association of TG/HDL and HOMA-IR with HTN in total subjects.

We aimed to investigate the association between excess body mass index (BMI) and papillary thyroid cancer (PTC) in an operative population, and the impact of higher BMI on clinicopathological aggressiveness of PTC. Charts of 10,844 consecutive patients with thyroid nodules undergoing partial or total thyroidectomy between 1993 and 2015 were reviewed. Patients diagnosed with PTC were stratified in 4 groups: BMI

Jinjing Wang,1,2,* Kang Chen,1,* Xinye Jin,1 Xueqiong Li,3 Ping An,1 Nan Yang,4 Yaolong Chen,4 Yi Fang,2 Yiming Mu11Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, People’s Republic of China; 2Department of Endocrinology, Fifth Medical Center of PLA General Hospital, Beijing 100071, People’s Republic of China; 3Department of Gerontology, First Affiliated Hospital of Kunming Medical University, Kunming 650031, People’s Republic of China; 4Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People’s Republic of China*These authors contributed equally to this work Objective: To evaluate the prognostic factors for cesarean section outcome of pregnant women with diabetes mellitus.Methods: MEDLINE, EMBASE, Cochrane Library, CBM, CNKI and Wanfang database were searched. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies. For pooled data with factors of perioperative outcome, the RevMan software was used for data translation and meta-analysis. The result is shown intuitively with the bubble diagram of evidence mapping by Excel 2016.Results: We included 12 randomized controlled trials (RCTs) in the meta-analysis. Twelve RCTs with 1,390 patients were included in the systematic review. The results show that the perioperative blood glucose management regimens, preoperative fasting and water deprivation, anesthesia regimens, postoperative fluid regimens, postoperative analgesia regimens, postoperative wound care regimens, psychological interventions, different dosing regimens for antibiotics, and obesity may affect the cesarean section outcome of diabetic mothers and newborns. The evidence for all the outcomes was low quality.Conclusion: Many prognostic factors have shown significant association with postoperative outcomes of cesarean section. More clinical research evidence with high-quality is needed.Keywords: gestational diabetes mellitus, caesarean section, prognostic factors, systematic review, meta-analysis, evidence mapping

Background. In patients with type 2 diabetes mellitus (T2DM) and poor glycemic control receiving metformin (MET), glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recommended as the adjunctive therapy. However, there are only a few studies involving the comparative effects of exenatide twice a day (EXBID) and exenatide once weekly (EXQW) on HOMA-β. This meta assessed the comparative effects of EXQW and EXBID on HOMA-β among T2DM patients. Materials and Methods. PubMed, Cochrane Library, and Embase databases were searched to collect randomized controlled trials (RCTs). Network meta-analysis was performed, and network diagrams were constructed to evaluate the effects. The primary outcome is HOMA-β, and the secondary outcomes are fasting blood glycose (FBG), glycated hemoglobin (HbA1c), and weight loss. Results. A total of 8 studies with 3506 subjects were included. Compared with other antidiabetic agents, EXQW has a greater improvement in HOMA-β than EXBID (weight mean difference WMD=‐0.46, 95% confidence interval (CI) [-0.64, -0.28], P=0.001). The effect of EXQW on HbA1c is superior to that of sitagliptin (SITA) (WMD=0.51, 95% CI [0.03, 0.99], P=0.037). The significant reduction of weight was detected for EXBID in comparison with EXQW (WMD=‐0.73, 95% CI [-1.13, -0.33], P=0.001), and no significant difference was found between EXQW and MET. Conclusions. EXQW shows a greater improvement in HOMA-β than EXBID. Moreover, the efficacy of EXQW on glycemic control is similar to other antidiabetic agents including EXBID. It is an advisable treatment for diabetic patients to improve HOMA-β and has an advantage of fewer number of injections compared with EXBID, to increase patients’ adherence and quality of life.

Despite great advances in lipid-lowering therapy, the gender-based disparities in lipid goal success among Chinese coronary heart disease (CHD) patients receiving lipid-lowering treatment remained uncharacterized. Furthermore, little is known about potential causes for this gender imbalance. This cross-sectional trial included 25 697 patients treated with lipid-lowering agents from 122 centres between April 2012 and October 2012; data for 9420 participants with CHD were analysed in the present study; all underwent clinical examination and had their latest fasting lipid profiles while on lipid-lowering therapy recorded. Logistic regression was used to explore possible factors associated with gender disparity in goal attainment rates, and to what extent each factor contributes. Of 9420 CHD patients (42.5% women) evaluated, women had a significantly lower overall low-density lipoprotein cholesterol (LDL-C) success rate than men (46.2 vs. 62.7%, P < 0.0001). Among CHD patients with diabetes, only 31.5% of women and 46.4% of men ( P < 0.0001) attained the optional LDL-C target of

Background: Systematic review which analyzes the impact of different anesthesia on intraoperative blood glucose levels of diabetes patients. Methods: We searched Medline (via PubMed), Embase, Cochrane Library, Web of Science, Wangfang, CNKI, and CBM database through June 2016, included in randomized controlled trial (RCT), about different anesthesia on intraoperative blood glucose levels in patients with diabetes. Two researchers in 1 group independently screened literatures with eligibility criteria, extracted information, and used RevMan5.3 software to perform meta-analysis. Results: We included 11 trials and performed the meta-analysis with 10 trials. The meta-analysis results suggested that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels (WMD −1.26, 95% confidence interval [CI] −1.77 to 0.76), the epidural anesthesia had no significant effects compared with general anesthesia (WMD −0.74, 95% CI 4.41–2.92), and the combined spinal-epidural anesthesia had no significant effects compared with epidural anesthesia (WMD −0.28, 95% CI −1.02 to 0.46). One study suggested that compared with epidural anesthesia, the combined general-epidural anesthesia can lower blood glucose levels Conclusion: Existing evidence showed that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels.

Tumor-induced osteomalacia (TIO) is an extremely rare metabolic bone disease and the occult offending tumor arising in facies cranii is even more uncommon. In this report, we described 2 middle-aged females with TIO caused by the tumor in facies cranii, which had ever been misdiagnosed as rheumatoid arthritis. Case 1 was present with diffuse bone pain and muscle weakness for 4 years, as well as esotropia in the right eye for 1 month. Case 2 was present with progressive bone pain in low back and hip for 2 years. Biochemical studies both showed persistent hypophosphatemia and urinary over wasting phosphate. Radiological examinations revealed the infiltrative mass in right apex partis petrosae ossis temporalis in case 1, and the soft mass in left nasal cavity and ethmoid sinuses in case 2, respectively. The offending tumors were resected completely in case 2, however, incompletely in case 1. Pathology examination revealed mixed connective tissue variant phosphaturic mesenchymal tumors. In conclusion, TIO should be presumed in patients presenting with unexplained persistent hypophosphatemia osteomalacia, also a thorough detection for tumor in facies cranii should be performed.

Disorder of the extracellular matrix has been suggested to play a role in the development of diabetic nephropathy. The aim of the present study was to examine the expression of matrix metalloproteinase-9 (MMP-9) in the kidney of Kkay mice, a type 2 diabetic model.Eight Kkay control mice (KA) and eight Kkay diabetic mice (KB) were fed with the same diets for 4 months and sacrificed after glucose levels and weight were measured. The renal pathological changes were examined by periodic acid-Schiff and periodic acid-silver methenamine staining, and the glomerulosclerosis indexes (GIs) were calculated. The levels of MMP-9 protein in the kidney tissue were assessed by immunohistochemistry. The gene expression of MMP-9 was measured by reverse transcription polymerase chain reaction.The diabetic group had morphological findings of diabetic nephropathy, and their GI (240.0+/-17.3) was much higher than that of the control group (118.4+/-15.1) (P.01). The mean positive area of MMP-9 protein in the glomeruli of Kkay mice in the KB group was higher than that in the KA group. The expression of MMP-9 messenger RNA level in the diabetic KB group was up-regulated when compared with the KA group.The expression of MMP-9 in the kidney of mice with diabetic nephropathy was enhanced, and MMP-9 might be involved in the development of diabetic nephropathy.

Homocysteine is a predictor of vascular disease and may have an important role in diabetes. In this study, we examined the effects of folic acid and methylcobalamin supplementation on changes in homocysteine (Hcy) levels and homocysteine thiolactonase/paraoxonase (HTase/PON) activity in a short-term trial.Ninety patients with type 2 diabetes were randomly divided into three groups: Group I received no vitamin supplementation, group II received 5 mg/day folic acid (orally), group III received folic acid (5 mg/day) in combination with methylcobalamin (500 microg/day; intramuscularly, on prescription). All patients were treated for 2 weeks. Plasma Hcy, HTase/PON activity, vitamin B(12), and folic acid were measured before and after supplementation in each group. In addition, forty healthy (nondiabetic) controls were enrolled.Serum HTase/PON activity was significantly higher in diabetics compared with controls, plasma Hcy levels were significantly lower (P0.05). After vitamin supplementation there was a significant reduction in plasma Hcy levels. The mean percentage reduction in Hcy was 2.75% in group I, 14% in group II and 37.3% in group III. There was a significant inverse correlation between the changes in HTase/PON activity and Hcy levels (r=-0.29, P=0.004). A 2.72% increase in HTase/PON activity was seen in group I, an 8.03% increase was detected when folic acid was given in group II (P0.001), and a 17.59% increase in HTase/PON activity was seen in group III (P0.001).Short-term oral folic acid (5 mg/day) supplementation with or without methylcobalamin appeared to be an effective approach to decrease Hcy levels and increase HTase/PON activity in patients with type 2 diabetes. A decrease in plasma Hcy levels may partly account for the elevation of serum HTase/PON activity. This could be a novel mechanism to protect against vascular diabetic complications.

Aim: To investigate the effect of telmisartan on the lipometabolisms and the proinflammatory factors secreted from 3T3-L1 adipocytes and to explore the possible mechanisms. Materials and methods: Telmisartan was applied to interfere with mature 3T3-L1 adipocytes. The culture’s free fatty acids, interleukin 6 (IL-6) and tumor necrosis factor α (TNFα) were evaluated. Oil Red O staining was used to determine the adipogenesis of 3T3-L1 adipocytes. 18 F-FDG uptake levels corrected for protein content were determined by cellular radioactivity. The total RNA was isolated for hybridization experimentation in the microarray. Results: Telmisartan reduced lipid storage and increased 18 F-FDG uptake in a dose-dependent manner, reduced the levels of IL-6 and TNFα and increased those of free fatty acids. One hundred and fifty-seven differentially expressed genes were found by microarray. The mitogen-activated protein kinase (MAPK) signaling pathway involved in the secretion of proinflammatory factor and lipid metabolisms was affected by telmisartan. The expression of endothelial nitric oxide synthetase gene 3 (Nos3) and carnitine palmitoyl transferase 1α (CPT1α) was up-regulated by telmisartan. Conclusions: Telmisartan affected lipometabolisms and the proinflammatory factors secreted from adipocytes. Nos3, CPT1α and the MAPK pathway being affected by telmisartan may be the underlying cause of the improvement in lipid metabolisms and secretion of proinflammatory factors of differentiated 3T3-L1 adipocytes.

Both ectopic pancreas and insulinoma are rare. A 21-year-old male patient had suffered from hypoglycemia episodes for 3 years and was diagnosed to have insulinoma based on biochemical and endocrinological evaluations. Various localization approaches revealed a distinct tumor outside the pancreas. With intraoperative endoscopy, the tumor in duodenohepatic ligament was identified and successfully resected. Pathologic evaluation revealed an ectopic insulinoma with ectopic pancreas. Therefore, when the biochemically confirmed insulinoma could not be well-definitely localized, the possibility of ectopic insulinoma should be suspected. In addition, radiography examinations and operation exploration should extend to the field where ectopic pancreas usually presents.

Purpose 17α-Hydroxylase deficiency (17OHD) is a rare type of secondary hypertension and well-known as a group of autosomal recessive disorders of adrenal steroidogenesis caused by a genetic disorder in one of the steroidogenic enzymes. At the same time, the knowledge of mitochondrial genetic basis for 17OHD is limited. Methods Clinical information, endocrine examination, computerised tomography (CT) scanning and mitochondrial genetic analysis were performed in one three-generation Han Chinese family with maternally transmitted hypertension. Results A 13-year-old female proband with genotypic 46, XY suffered from 17OHD (male pseudohermaphroditism) was detected. She presented with hypertension, primary amenorrhea, and lack of secondary sexual characteristics. Laboratory tests showed hypokalaemia, low levels of androgens (testosterone and dehydroepiandrosterone), corticosteroid, high levels of adrenocorticotropic hormone and progesterone. CT scanning found bilateral adrenal hyperplasia, womb and ovaries deficiency. The other matrilineal relative in this family exhibited the variable degree of hypertension and hypokalaemia. Full sequence analysis found mitochondrial variant A8343G (belong to haplogroup H) located at the position of A54 at the TΨC arm of tRNA Lys gene in all matrilineal pedigrees, not in 270 controls. The variant A8343G may modulate mitochondrial K + transport, lead to decrease of tRNA metabolism, increase of angiotension II level, enhance of mtROS generation and influence the transcription of tRNA herein affect the steady-level of protein synthesis. Conclusions The findings suggested that A8343G in mitochondrial tRNA Lys gene may have biologic plausibility to implicate in the pathogenesis of 17OD in the three-generation Han Chinese family.