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01 October 2014, Volume 34 Issue 10 Previous Issue    Next Issue

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Research on identification of high-risk obesity. JI Ming，ZOU Da-jin. 2014, 34(10): 933-938.  DOI: 10.7504/nk2014090101 Abstract ( )   PDF (986KB) ( )   Abstract：Obesity is not only influenced by hereditary factors，but also complicated with disturbances of free fatty acid metabolism.It is closely related to abnormal levels of many adipokines and note，high-risk obesity is intimately correlated with Non Alcoholic Fatty Liver Disease(NAFLD)，hypertriglyceridemia，hyperinsulinemia，Obstructive Sleep Apnea Syndrome （OSAS）and Polycystic Ovarian Syndrome (PCOS).Early identification of the clinical characterisitic of high-risk obesity and timely prevention could yield good results.

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Clinical research and application of carbon glycosidase inhibitors. YANG Wen-ying. 2014, 34(10): 937-939.  DOI: 10.7504/nk2014090201 Abstract ( )   PDF (536KB) ( )   Abstract：Glucosidase inhibitors (AGI) reduce postprandial hyperglycemia by delaying carbohydrate absorption，first-line therapy is applied widely in type 2 diabetes mellitus patients.Study on evidence-based in recent years show，acarbose can also through the regulation of intestinal flora and gastrointestinal hormones in patients with type 2 diabetes，improve blood glucose and other metabolic indices，these new mechanisms of action for AGI drugs，will bring more broad prospects for clinical application.

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The clinical experience of GLP-1 receptor agonist drugs. ZHU Yan-hua，WENG Jian-ping. 2014, 34(10): 942-946.  DOI: 10.7504/nk2014090202 Abstract ( )   PDF (822KB) ( )   Abstract：Increased understanding of the role of incretin hormones in maintaining glucose homeostasis has enabled the development of pharmacotherapy that target deficient incretin activity in type 2 diabetes mellitus.Glucagon-like peptide-1 (GLP-1) is a peptide hormone secreted from the small intestine in response to nutrient ingestion.Because of the short circulating half-life of the native GLP-1，novel GLP-1 receptor (GLP-1R) agonists have been developed to facilitate clinical use.GLP-1R agonists stimulate insulin secretion in a glucose dependent manner.GLP-1R agonists can inhibit glucagon secretion and gastric emptying and reduce appetite.As new antidiabetic drugs，GLP-1R agonists have been widely used.BEmerging evidence indicate that GLP-1-based therapy are safe and may provide cardiovascular-benefits beyond glycemic control.This article reviews the clinical aspects of efficacy and safety of GLP-1R agonists and elucidates their roles in treating type 2 diabetes mellitus.

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The clinical summary of thiazolidinediones in the treatment of T2DM. CHEN Li-ming. 2014, 34(10): 947-951.  DOI: 10.7504/nk2014090203 Abstract ( )   PDF (763KB) ( )   Abstract：Thiazolidinediones are insulin sensitizers developed specifically for T2DM，which mainly act via decreasing insulin resistance of tissues，including adipocyte，liver，and muscular，and protecting pancreatic β cells to improving hyperglycemia and cholesterol.It is always a controversy whether or not thiazolidinediones have bigger clinical benefits than its risks.This article will attempt to illustrate the effect and safety based on science evidences of TZDs.

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The clinical experience of DPP-4 inhibitor. ZOU Da-jin. 2014, 34(10): 952-958.  DOI: 10.7504/nk2014090204 Abstract ( )   PDF (965KB) ( )   Abstract：Type 2 Diabetes Mellitus (T2DM) is exacting a high level of patient suffering and social cost worldwide.The past several decades witnessed intensive investigations on new lines of therapeutics regimen for T2DM.Among them，there is a new class of oral anti-hyperglycemic agent called dipeptidyl peptidase-4 inhibitor which includes Sitagliptin，Saxagliptin，Vildagliptin，Alogliptin and Linagliptin.In the current review，we are endeavored to provide a comprehensive overview on clinical and translational evidence of DPP-4 inhibitor action and the safety profile.Particularly，we are interested in reviewing evidence on the underlying mechanism for blood glucose control，micro and macro vascular benefits，clinical data which involves Sitagliptin as monotherapy and combined therapy and beneficial effects beyond blood glucose control.The data currently available strongly suggest DPP-4 inhibitor is an effective oral anti-hyperglycemic agent with optimal safety profile.Thus，it has been recommended by numerous high-impact guidelines as a major second-line (ADA，CDS) or even optional first-line for elderly T2DM patients (IDF).

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The clinical experience of glinides. LI Juan，TONG Nan-wei. 2014, 34(10): 959-961.  DOI: 10.7504/nk2014090205 Abstract ( )   PDF (523KB) ( )   Abstract：Glinides are nonsulfonylurea insulin secretagogues which are commonly used in China，mainly including repaglinide and nateglinide.In the article，the clinical experience of glinides will be stated including its application at home and abroad，hypoglycemic effect，adverse effect，the combination with insulin，the application in the patients with CKD，the medication principle，and so on.

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SGLT2 inhibitors-new way for the treatment of type 2 diabetes. GU Guang-yu，ZHENG Shao-xiong. 2014, 34(10): 962-968.  DOI: 10.7504/nk2014090206 Abstract ( )   PDF (1078KB) ( )   Abstract：With the progress of type 2 diabetes and β cell failure，traditional medications may not meet type 2 diabetes complicated clinical needs.SGLT2-inhibitors，highly selective SGLT2-inhibitors，are a new class of oral antidiabetics.By inhibiting SGLT-2 in the renal tubules，SGLT2-inhibitors decrease renal glucose absorption and thereby calorie loss with improved glycemic control and weight loss.SGLT2-inhibitors are well tolerated and have a low propensity to cause hypoglycaemia.New therapies with complementary mechanisms of action that are independent of insulin secretion or action may provide additional therapeutic options to enable patients to achieve glycaemic control.

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The look at sulfonylurea compounds. ZHANG Li-na,GUO Li-xin. 2014, 34(10): 969-973.  DOI: 10.7504/nk2014090207 Abstract ( )   PDF (888KB) ( )   Abstract：Sulfonylurea compounds were the first oral antidiabetic agents in the world.They are important in optimal glucose control.Sulfonylureas not only have the function of stimulating insulin releasing from β-cells of pancreas，but also have some extrapancreatic effects，such as decreasing the clearance of hepatic insulin，reducing the secretion of glucagon in patients with type 2 diabetes mellitus and so on.Sulfonylurea compounds were the primary pharmacotherapy for type 2 diabetes mellitus patients，but their safety and clinical utility caused some controversy because of inducing the risks of hypoglycemia，gain of weight，causing cardiovascular disease outcomes and cancer in recent years.In this work，we reviewed the biological mechanisms of sulfonylureas，the efficacy of its oral taken in T2DM and the side effects of its usage and so on.

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Differences in clinical features between biomass smoke-induced COPD or cigarette smoke-induced COPD. CHENG Lin-ling*，LIU Ya-ya，SU Zhu-quan，LIU Jun，CHEN Rong-chang，RAN Pi-xin. 2014, 34(10): 992-995.  DOI: 10.7504/nk2014090401 Abstract ( )   Abstract：Objective To evaluate the clinical differences between COPD due to tobacco and to biomass smoke.Methods We retrospectively studied the records of 287 patients diagnosed of COPD due to tobacco or to biomass smoke exposure.Results (1)genernal information：including sex，age and body index，et al.(2)clinical symptom：including dyspnea and other symptom.(3)COPD assessment，including lung function assessment and combinated COPD assessment.(4)Exacerbation of COPD.Result(1)There were more males in the tobacco group(83.5% vs 16.5%)，while there were more females in the tobacco group(85.2% vs 14.8%)(χ2=27.2，P<0.05).Body index values of female patients were lower in the biomass group compared with tobacco group.There was no difference of age between two groups.(2)Dyspnea index(mMRC)were similar between both groups；Wheezing was more common in biomass group compared with tobacco group(38.3% vs 11.1%)(χ2=17.9，P<0.05).There were more complication(such as allergic rhinitis and asthma)in biomass group compared with tobacco group(43.2% vs 18%)(χ2=16.1，P<0.05).There were more lung cancer in tobacco group compared with biomass group(7.77% vs 3.7%)(χ2=9.7，P<0.05).(3)COPD assessment：More patients were classified in GOLD B or D stage in the biomass group than in the tobacco group.(4)Exacerbation of COPD：Exacerbation of COPD were also similar between the biomass and tobacco groups.Conclusion There are several clinical differences between patients with COPD due to tobacco and to biomass smoke exposure.There were more females in the biomass group.Female patients in biomass group have low body mass index，more clinical symptom and more complication(such as allergic rhinitis and asthma).More patients were classified in GOLD B or D stage in the biomass group；There were more males in the tobacco group.Patients in tobacco group have more complication(such as lung cancer).

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Expression and significance of toll-like receptor 5，NF-kappaB and interleukin 17 in patients with ulcerative colitis. LI Lin-jing，LI Zhi-guo，ZHU Li-ping，JIANG Hong-yan，LIU Jing，FENG Bai-sui 2014, 34(10): 996-998.  DOI: 10.7504/nk2014090402 Abstract ( )   Abstract：Objective To explore the expression of Toll-like receptor 5(TLR5)，NF-KappaB(NF-κB) and Interleukin-17 (IL-17) and analyse their relationship in patients’ colon tissue and peripheral blood with ulcerative colitis (UC).Methods A total of 70 initially active UC patients were collected，among which 30 patients were mild UC，25 patients were moderate and 15 patients were severe UC.Their peripheral blood and colon mucosa were collected.The colon mucosa tissues from 15 cancer patients were collected as tissue control，blood samples from 30 healthy volunteers were collected as serum control.BThe expression of TLR5 and NF-κB in the colon mucosa were measured by immunohistochemistry，and the level of IL-17 in serum were detected by ELISA.Results As compared with control group，the TLR5，NF-κB and IL-17 in UC group were significantly increased (P<0.01).And the severe and moderate group were significantly higher than mild group.What’s more，the expression of TLR5 were positively correlated with NF-κB and IL-17(P<0.01).Conclusion TLR5 can induce activation of transcription factor NF-κB to enhance the expression of IL-17，all of which is involved with the the occurrence and development of UC.

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Desmopressin stimulation test for the differential diagnosis of ACTH dependent Cushing syndrome. MAO Jiang-feng*，CAI Xiao-feng，LIU Li-ping，CHEN Shi，WANG Zhi-xin，LU Lin，LU Zhao-lin. 2014, 34(10): 1000-1003.  DOI: 10.7504/nk2014090403 Abstract ( )   Abstract：Objective To clarify the values of DDAVP stimulation test in the differential diagnosis of ACTH dependent Cushing syndrome.Methods To calculate the sensitivity and specificity of DDAVP stimulation test for the diagnosis of Cushing’s disease by retrospectively reviewing the clinical results from 41 patients with Cushing syndrome.The clinical data includes high dosage dexamethasone depression test，DDAVP stimulation test，inferior petrosal sinus sampling (IPSS) and sellar MR images.Ten patients with ectopic ACTH syndrome，from the other studies，were recruited for data analysis.The exploration for false-negative results was conducted by comparing the different levels of ACTH between IPSS and DDAVP stimulation test.Results (1) Totally 28 patients with Cushing’s disease and 13 patients with ectopic ACTH syndrome were recorded.(2) The ratio of ACTH max/ACTH basal was taken as a marker for ACTH increment.Taken the ratio of 1.5 as a cut point，the sensitive and specific rate of Cushing’s disease was 82% and 62% respectively.Taken the ratio of 3 as a cut point，the sensitive and specific rate of Cushing’s disease was 50% and 100%，respectively.(3) Twelve patients performed IPSS.At the baseline，the ratio (ACTH inferior petrosal sinus /ACTH peripheral) was 17.3±5.4 and the central level of ACTH significantly increased after DDAVP injection.Conclusion The peripheral level of ACTH would increase in 80% patients with Cushing’s disease after DDAVP injection.A greater increment in ACTH indicates a greater chance for Cushing’s disease and an increment in ACTH above three folds of the baseline makes the diagnosis more definitive.

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Characteristics of intravascular ultrasound image of target borderline lesion in the proximal left anterior descending artery. WANG Bin，HAN Ya-ling，JING Quan-min，MA Ying-yan，WANG Xiao-zeng，WANG Geng，LIU Hai-wei，XU Kai 2014, 34(10): 1004-1007.  DOI: 10.7504/nk2014090404 Abstract ( )   Abstract：Objective To investigate the characteristics of intravascular ultrasound(IVUS) image of target borderline lesion in the proximal left anterior descending artery(LAD) for finding the basement to treating these patients with the lesions.Methods The borderline lesions with 30%-50% dimension stenosis in the proximal LAD were found in 10 patients with coronary artery disease from June，2010 to October，2011.All the 10 patients had some discomfort in the precordium，including 7 males，1 with diabetes，3 with hypertension，1 with hypercholesterolemia，2 smokers and 2 with infarct history.The intervention was done in the patient with the typical syndrome after IVUS for identify the distribution of plaque in the proximal LAD.For the atypical patients，the exercise test was done firstly.The intervention was done in the positive patient after IVUS.Results The discomfort in the precordium disappeared in all the 10 patients.The minimal lumen area(MLA) of them in the proximal LAD was (4.85±1.49)mm2.MLA in the 7 patients was more than 4 mm2.The area stenosis(AS) of them in the proximal LAD was 69.99%±7.07%.AS in the 4 patients was less than 70%.Conclusion In the proximal LAD，it is unreliable that 4 mm2 of MLA or 70% of AS was considered to the cut-off value for the intervention therapy.The suitable strategy to the patients with borderline lesion in the proximal LAD should come from the combination of IVUS

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Comparison of drug eluting stent for treatment of early and late in-stent restenosis. ZHANG Yu-chen，ZHAO Lin，LI Yu，CHEN Fang 2014, 34(10): 1008-1011.  DOI: 10.7504/nk2014090405 Abstract ( )   Abstract：Objective Compare the efficiency and safety of drug eluting stent (DES) for treatment of early and late in stent restenosis(ISR).Methods Patients treated with DES for ISR and de novo lesions in Beijing Anzhen Hospital between October 2008 and December 2011 were followed up for 1 year.All lesions were divided into early and late ISR group.Major adverse cardiovascular events (MACE) including all-cause death，myocardial infarction (MI) and clinical target lesion revascularization (TLR) were the primary endpoints.Results The study population consisted of 80 patients in early ISR group and 124 patients in late ISR group.Baseline clinical and angiographic parameters were comparable between the two groups.The rate of TLR in early ISR group was higher than that in late ISR group (26.3% to 12.1%，P<0.05)，contributing to higher MACE in early ISR group(30.0% vs 15.3%，P<0.01).Conclusion DES implantation is safe and effective for treatment of ISR lesions，but the rate of TLR for treatment of early ISR lesions is higher compared to treatment of late ISR lesions.