Thyrotropin (TSH) is a modulator of glucose metabolism by binding to its receptor on pancreatic cells. We used thyrotropin receptor (TSHR) knockout mice (Tshr-/-) as a model of TSH deletion to study its function in pancreatic β cells. Tshr-/- mice had a similar body weight at birth compared with Tshr+/+ mice, but grew at a significantly slower rate until adulthood with adequate thyroxine supplementation. TSH deletion led to lower fasting and postprandial blood glucose, insulin secretion impairment, and atrophy of islets in adult mice. Transcription factors and markers of pancreatic β cell maturation, Pdx1, Nkx6.1, Glut2, and insulin, together with cell proliferation marker Ki67 showed no differences at the mRNA level between the two groups. However, the Bax/Bcl-2 ratio was remarkably elevated in Tshr-/- mice at both mRNA and protein levels. We hypothesized that pancreatic cell apoptosis, rather than abnormal cell proliferation and maturation, is associated with pancreatic dysfunction and glucose intolerance in the absence of TSH modulation.

Background. The prevalence of diabetes and potentially related complications, including stroke, is rapidly increasing in China. The long-term effects of lifestyle may affect glucose metabolism in the general population. Although some studies have shown an association between smoking and the risk of type 2 diabetes mellitus (T2DM), the relationship remains unclear. Furthermore, the relationship between smoking and stroke in patients with T2DM has not been fully elucidated. Objective. We investigated the influence of cigarette smoking on T2DM and stroke in China. Detailed questionnaires about smoking status and anthropometric measurement were completed by participants, and oral glucose tolerance testing (OGTT), hemoglobin A1c (HbA1c), homeostasis model assessment of IR (HOMA-IR), and blood lipids were measured. Results. In total, 8196 adults aged 40 years or older were included. We found a reduced risk of impaired glucose regulation (IGR) and T2DM in male smokers with normal weight (body mass index BMI<25 kg/m2 or waist circumference WC<90 cm) compared with nonsmokers after adjusting for age, alcohol intake, physical activity, educational level, family history of diabetes, SBP, DBP, TG, TC, HDL-C, and LDL-C. However, no significant association was detected in male current smokers with overweight/obesity or female smokers. In addition, compared with nonsmokers without T2DM, current smokers with T2DM had a significantly higher risk of stroke (odds ratio: 2.64, 95% confidence interval: 1.25–5.57; P=0.011) after adjusting for confounders. Conclusions. Smoking was negatively associated with T2DM in Chinese men of normal body weight, but no significant association was found for men with overweight/obesity or women. In addition, smoking was positively associated with nonfatal stroke, especially in patients with T2DM. Further prospective studies are needed to examine the association between smoking, diabetes, and stroke in different ethnic groups.

The purpose of our study is to examine the association between serum GGT levels and ventricular instability in Chinese patients with T2DM. We conducted a cross-sectional, community-based study in Nanjing, China from June to November 2011. Among 10,050 patients aged 40–79 years, we enrolled 2444 with pre-diabetes, 2496 with T2DM, and 4521 without diabetes (non-diabetes). Electrocardiograms were performed to measure the QT interval corrected for heart rate (QTc) and QT interval dispersion (QTd). Serum GGT levels, metabolic parameters, body mass index, and blood pressure were also measured. We found that there were no significant associations of increased QTc/QTd with serum GGT levels in participants with pre-existing T2DM and non-diabetes, after adjusting for age, duration of diabetes, and metabolic parameters. Even after adjustment, higher risks of QTc ≥ 440 ms/√s and QTd ≥ 58 ms were found in participants with serum GGT levels ≥49 U/L compared with those with <15 U/L in the pre-diabetes (QTc: OR 1.96, 95 % CI 1.23–2.47; QTd: OR 1.34, 95 % CI 1.07–1.94) and newly diagnosed T2DM (QTc: OR 2.01, 95 % CI 1.39–2.51; QTd: OR 1.53, 95 % CI 1.03–1.99) groups. We conclude that Increased serum GGT levels are associated with some markers of ventricular repolarization abnormalities in the early stage of T2DM.

CONTEXT:Insulin resistance (IR) is an important factor for the growth and progression of thyroid nodules, which might be associated with the distribution, construction, and density of nodular vascularization.OBJECTIVE:The objective of the study was to explore the association between IR and the vascularization of thyroid nodules.DESIGN AND SETTING:A cross-sectional, population-based study was conducted in Nanjing, China, from June to November 2011.PARTICIPANTS:Among 10 050 participants aged 40-79 years, 2886 thyroid nodule cases were detected and 2532 cases met eligibility criteria for enrollment in the study.MAIN OUTCOME MEASURES:Power Doppler was performed to measure the flow patterns, resistive index (RI), and vascular index (VI) of thyroid nodular vascularization. Fasting insulin, fasting glucose, 2-hour oral glucose tolerance test, glycosylated hemoglobin (HbA1c), homeostasis model assessment of IR (HOMA-IR), and body mass index were also tested.RESULTS:HOMA-IR (R = 0.35, P < .001) and HbA1c (R = 0.19, P < .001) were positively correlated with thyroid nodular flow patterns, and the positive correlations were more significant in participants with large nodules (volume ≥ 0.2 mL). Additionally, in participants with large nodules, HOMA-IR and HbA1c were positively correlated with RI (HOMA-IR: β = .42, SE = .03, R = 0.43, P < .001; HbA1c: β = .22, SE = .04, R = 0.23, P < .001) and VI (HOMA-IR: β = .49, SE = 0.05, R = 0.53, P < .001; HbA1c: β = .34, SE = 0.11, R = 0.37, P < .001).CONCLUSIONS:IR and hyperglycemia were positively correlated with the flow patterns, RI, and VI of thyroid nodules, especially in large nodules. The findings suggest a pivotal role of IR in the distribution, construction, and density of thyroid nodular vascularization, which might contribute to the growth and the progression of thyroid nodules.

To explore the association of sleep patterns with bone mineral density (BMD) in pre- and post-menopausal women, we used a questionnaire to evaluate the sleep patterns and performed calcaneal quantitative ultrasound to estimate BMD, in 6,510 women aged 40 years or older, from June to November 2011 in Nanjing City. We found a 1.7-fold risk of osteoporosis in post-menopausalwomen with bedtime of ≥0:00 am (OR = 1.69, 95 % CI 1.39–2.13), compared to those whose bedtime of <0:00 am. post-menopausalwomen with excessive total sleep (>10 h vs. 8–9 h, OR = 1.54, 95 % CI 1.05–2.02) were shown to have a higher risk of osteoporosis, however, this high risk was not detected in those with excessive nocturnal sleep (>10 h vs. 8–9 h, OR = 0.85, 95 % CI 0.62–1.30). By contrast, post-menopausalwomen with inadequate nocturnal sleep (≤7 h vs. 8–9 h, OR = 1.68, 95 % CI 1.32–2.75), excessive daytime sleep (≥180 min vs. 0 min, OR = 1.52, 95 % CI 1.08–2.13), and noontime nap (>60 min vs. 0 min: OR = 1.37, 95 % CI 1.06–1.76) were demonstrated to have higher risk of bone loss. Nevertheless, these associations were not found in premenopausal women. We conclude that delayed bedtime, nocturnal sleep deprivation, excessive daytime sleep, and noontime nap, but not reduced total sleep duration, could promote bone loss in post-menopausalwomen, which might be related to circadian rhythm disturbances. However, they have limited influences to BMD in women who were still in menstruating. Mechanism responsible for the phenomena warrants further investigation.

The purpose of the study was to explore the association of menstrual and reproductive factors with thyroid nodules in Chinese women older than 40 years of age. A questionnaire was completed by 6,571 women aged 40 years or older in a community-based epidemiological investigation of thyroid nodules conducted from June to November 2011 in Nanjing City. Thyroid nodules were measured by ultrasound. The Thyroid Imaging Reporting and Data System score was used to differentiate between benign and possibly malignant nodules. Menopausal age (>55 vs. <50 years: RR = 1.17, 95 % CI 1.00–1.34) and number of reproductive years (>40 vs. <35 years: RR = 1.12, 95 % CI 1.01–1.24) increased the risk of thyroid nodules, but were not associated with suspected malignant nodules. Women who experienced more pregnancies (≥5 vs. ≤1: RR = 2.09, 95 % CI 1.79–2.40) and abortions (≥3 vs. 0: RR = 1.61, 95 % CI 1.41–1.81) were prone to development of thyroid nodules, and more likely to form suspected malignant nodules (pregnancies, RR = 3.59, 95 % CI 1.60–7.20; abortions, RR = 2.36, 95 % CI 1.31–4.06). Furthermore, higher risks of thyroid nodules (RR = 1.36, 95 % CI 1.14–1.59) and suspected malignant nodules (RR = 2.80, 95 % CI 1.08–6.53) were observed in women who had undergone artificial compared with natural abortion. Periods of elevated estrogen and progesterone levels in women, such as pregnancy, were the key occasions for occurrence of both benign and suspiciously malignant thyroid nodules, while longer lifetime length of exposure to female sex hormones might promote the growth of thyroid nodules.

Objective To investigate the impact of psychological features on the postoperative complications, nursing-time and costs during the intensive care unit (ICU) in children with congenital heart disease (CHD), and to provide scientific evidence for improving the nursing in these patients. Methods 182 children with CHD were divided into the rejection group and the cooperation group based on their psychological evaluation before the operation. Then the postoperative complications, nursing-time and costs during ICU were compared. Results In the rejection group, the postoperative complications (40.6%), nursing-time (26.1± 16.9 h) and costs (4 569.0±4 825.8 Yuan) during ICU were significantly higher than those in the cooperation group (P<0.05). Conclusions The psychological features in children with CHD have a strong impact on the postoperative rehabilitation and health economics. It's necessary to do a psychological evaluation and intensive mental care in preoperative children with CHD to reduce the rejection patients, and in turn to reduce the postoperative complication, promote the rehabilitation, reduce the costs and save the medical resource.