The COVID-19 pandemic, caused by SARS-CoV-2, has resulted in a significant increase in insulin resistance and new-onset diabetes among recovered individuals. This review examines the multifactorial mechanisms underlying these metabolic complications, including activation of the immune system and inflammatory cascades, lifestyle changes, nutritional deficiencies, imbalances in amino acid metabolism, alterations in ketogenesis, disruptions in the gut microbiome, psychological impacts, and COVID-19 vaccines. We discuss how these factors collectively contribute to insulin resistance, particularly in the context of COVID-19, and highlight potential therapeutic strategies, such as dietary interventions and ACE2 activators, that may mitigate these effects. Our analysis underscores the need for targeted approaches to prevent and treat insulin resistance in post-COVID-19 patients, emphasizing the importance of understanding the pandemic’s long-term metabolic consequences.

ObjectiveThyroid hormones play critical roles in regulating bone turnover and maintaining bone mass. However, the relationship among thyroid hormones, their sensitivity indices, bone mineral density (BMD) and fracture risk remained unclear in the Chinese osteoporotic population. This study aimed to investigate the associations between thyroid hormones, their sensitivity indices, and both volumetric BMD (measured by quantitative computed tomography, QCT-BMD), areal BMD (measured by dual-energy X-ray absorptiometry, DXA BMD), as well as the risk of vertebral fractures, among primary osteoporotic individuals aged over 50 years old of euthyroid adults in northern China (north of the Yellow River).MethodsA total of 1, 386 men and postmenopausal women (aged ≥50 years) with euthyroidism and primary osteoporosis were recruited from Beijing Jishuitan Hospital during January 2021 to December 2024. Participants were divided into two groups: those without vertebral fractures (n = 856) and those with vertebral fractures (n = 530). Demographic characteristics, serum bone turnover markers (ALP, tP1NP, β-CTX, OC, PTH), thyroid hormones (TT4, TT3, TSH, FT3, FT4), thyroid hormone sensitivity indices (FT4/FT3, TSHI, TT4RI, TFQI), lumbar QCT-BMD, lumbar DXA-BMD, and total hip DXA-BMD were compared between groups. Univariate and multivariate logistic regression analyses, restricted cubic spline (RCS) regression, and subgroup analyses were performed to evaluate the independent effects of thyroid hormones and their sensitivity indices on BMD measures and vertebral fracture risk, adjusting for potential confounders including age, sex, BMI, smoking, alcohol consumption, diabetes, hypertension, and hyperlipidemia.ResultsThe vertebral fracture group exhibited significantly higher TT3 levels compared to the non-fracture group (TT3: 1.98 [1.60, 2.89] vs. 1.76 [1.50, 1.91] nmol/L, P < 0.001), while TT4 levels were significantly lower than the non-fracture group (TT4: 89.50 [39.65, 101.00] vs. 103.00 [85.60, 115.00] nmol/L, P < 0.001). No significant difference was observed for TSHI, TT4RI, or TFQI between groups. After multivariable adjustment, elevated TT3 remained independently associated with increased lumbar fracture risk (OR (95% CI): 1.02 [1.01–1.04], P = 0.018), the positive relationship remained significant in RCS analysis (P < 0.001). TSH showed a significant positive association with lumbar QCT-BMD (β (95% CI): 0.89 [0.07–1.71], P = 0.034) and in RCS analysis(P = 0.013). In contrast, FT4/FT3 and FT3 were positively associated with lumbar QCT-BMD in the adjusted logistic regression (β (95% CI): 12.08 [6.18~17.98], P < 0.001; β (95%CI):3.69 (0.31 ~ 7.07), P = 0.033), but exhibited a nonlinear and negative association with lumbar QCT-BMD in RCS analysis (P = 0.003, P = 0.008). Subgroup analyses stratified by gender, age, BMI, diabetes, hypertension, hyperlipidemia, cardiovascular disease, smoking, and alcohol drinking revealed significant interaction effects between FT4/FT3 and lumbar QCT-BMD in gender-specific (P-interaction = 0.046) and age-specific analysis (P-interaction = 0.021). Notably, in individuals under 60 years old, higher FT4/FT3 was associated with increased lumbar QCT-BMD(β (95% CI): 10.62 [2.84–18.40], P = 0.009).ConclusionOur findings demonstrated that thyroid hormones—specifically FT3, TT3, TSH—and the peripheral thyroid hormone sensitivity index FT4/FT3 were more strongly associated with vertebral fracture risk and bone mineral density. Notably, these associations were more pronounced with vBMD measured by QCT. Collectively, these results highlighted the potential role of FT3, TT3, TSH, and the peripheral thyroid sensitivity index FT4/FT3 as indicators of bone mass and fracture risk prediction in this population.

AIMS:Glucokinase regulatory protein gene (GCKR) polymorphisms have been linked to progressive renal dysfunction in diabetic populations. However, their role in early renal injury of diabetic kidney disease (DKD) remains unclear. This study aimed to investigate the association between GCKR genetic variants and early renal impairment in newly diagnosed early-onset type 2 diabetes mellitus (T2DM). METHODS:A total of 337 newly diagnosed early-onset T2DM patients from a prospective cohort were enroled. Baseline characteristics, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (UACR) were collected. Seven single nucleotide polymorphisms (SNPs) in GCKR were genotyped using ASAMD microarrays. Participants were divided into normal (UACR < 30 mg/g) and elevated albuminuria (UACR ≥ 30 mg/g) groups. Logistic regression and multivariate linear regression were performed to evaluate the relationship between GCKR genotypes and UACR. RESULTS:The patients had a mean age of 33.25 ± 5.38 years. Median eGFR was 119.33 mL/min/1.73 m2, and median UACR was 14.97 mg/g; 107 patients (31.8%) presented with elevated UACR. Carriers of the GCKR rs1260326 T/T genotype exhibited significantly higher median UACR compared with C/T + C/C carriers (22.85 vs. 13.53 mg/g, p = 0.021). The rs1260326 T allele was independently associated with increased UACR under the additive genetic model (p = 0.003) adjusted for sex, age, body mass index (BMI), glycated haemoglobin (HbA1c), and systolic blood pressure (SBP). CONCLUSIONS:The GCKR rs1260326 T allele is independently associated with early renal injury in newly diagnosed early-onset T2DM. This genetic variant may serve as a predictive marker for early DKD risk stratification in this high-risk population.

BACKGROUND AND AIM:Accumulating evidence suggests maturity onset diabetes of the young (MODY) caused by GCK gene mutations (GCK-MODY) is often misdiagnosed as Gestational Diabetes Mellitus (GDM) in pregnant women. This study investigated the prevalence and diagnostic value of GCK gene mutations in Chinese GDM patients. METHODS:A retrospective analysis was conducted on 3394 pregnant women undergoing prenatal care or delivery at Beijing Jishuitan Hospital between April and December 2019. GDM was diagnosed in 474 women (14.0%) using the International Association of Diabetes and Pregnancy Study Groups (IADPSG, 2010) criteria via a 75 g Oral Glucose Tolerance Test (OGTT). Among these, 177 GDM patients with fasting blood glucose ≥5.1 mmoL/L underwent targeted GCK gene sequencing. RESULTS:Targeted sequencing identified eight rare GCK variants in nine individuals. None of the variant carriers met definitive diagnostic criteria for GCK-MODY. The prevalence of rare GCK variants in the screened GDM subgroup was 1.9% (9/474). CONCLUSION:The low prevalence (1.9%) of rare GCK variants and absence of confirmed GCK-MODY cases indicate limited utility of fasting glucose-based screening for GCK-MODY in Chinese GDM populations. These findings highlight challenges in distinguishing GCK-MODY from GDM through conventional glucose thresholds.

The prevalence of early-onset type 2 diabetes (EOD) is rapidly increasing. This study intends to screen for early cardiovascular abnormalities in patients newly diagnosed with EOD and evaluate the cardiovascular risk across cluster phenotypes. A total of 400 patients ≤ 40 years old with newly diagnosed type 2 diabetes were enrolled from the START cohort (the Study of The newly diAgnosed eaRly onset diabeTes). Cluster classification was performed using the K-means method based on age, BMI, HbA1c, HOMA2-β, HOMA2-IR, and GAD antibodies. Echocardiography and carotid ultrasound were performed within 3 months of diabetes diagnosis. Carotid ultrasound abnormalities included intimal thickening and plaque formation, while echocardiography assessed changes in cardiac structure and systolic/diastolic function. Cluster-specific partitioned polygenic scores (pPS) were used to validate our findings from a genetic perspective. Carotid artery abnormalities were detected in 26.3

Nonalcoholic fatty liver disease (NAFLD) become a main public health concern, and is characterized by lipid accumulation in the hepatocytes. We found that overexpression of lncRNA MEG3 significantly reduced the expression of FOXO1, ACC1, and FAS, and subsequently decreased the lipid accumulation in HepG2 cells. Moreover, inhibition of lncRNA MEG3 could increase the lipid accumulation and the mRNA and protein levels of FOXO1, ACC1, and FAS. Further study showed that lncRNA MEG3 regulates the lipogenesis process by inhibiting the entry of FOXO1 into the nucleus translocation. Our study demonstrated that lncRNA MEG3 regulates de novo lipogenesis by decreasing the expression and nucleus translocation of FOXO1 in HepG2 cells, suggesting that lncRNA MEG3 could be a promising therapeutic target in lipid metabolic disorders.

Primary hypertrophic osteoarthropathy(PHO)is a rare disease also known as pachydermo-periostosis.We reported a painless case whose diagnosis was confirmed by genetic test.A 24-year-old male presented a series of symptoms that first began at 14.He suffered from progressive clubbed-fingers accompa-nied by swelling of the wrist and ankle joints.Facial skin concentric thickening and alar nose broadening ap-peared simultaneously and increased progressively.He was also prone to acne and hyperhidrosis.X-rays showed thickening of the metacarpal and phalangeal bones,as well as symmetrical periosteal ossification of both the tibia and fibula.Clinical diagnosis of PHO is difficult because of the variable features.With acromeg-aly excluded,the diagnosis was confirmed by a genetic test.Whole exome sequencing revealed a heterozygous SLCO2A1 c.611C＞T(p.Ser204Lue)and SLCO2A1 c.1602C＞A(p.Asn534Lys)mutation from each par-ent.It suggests that primary hypertrophic osteoarthropathy should be considered for young limb hypertrophic patients especially when periosteal thickening signs were showed in X-ray.A confirmatory diagnosis can be made through the genetic test.

Purpose: To investigate the age and gender differences in vertebral bone marrow adipose tissue (BMAT) and volumetric bone mineral density (vBMD).Method: A total of 427 healthy adults, including 175 males (41 %) and 252 females (59 %) with an age range of 21-82 years, underwent MRI and quantitative CT examinations of the lumbar spine (L2-L4), and the corresponding BMAT and vBMD values were measured. The age-related progressions of BMAT and vBMD in men and women were evaluated and compared.Results: In males, vertebral BMAT rose gradually throughout life, while in females, BMAT increased sharply between 41 and 60 years of age. In participants aged < 40 years, BMAT was greater in males compared to females (p <= 0.01), while after the age of 60, BMAT was higher in females (p < 0.05). In males, vBMD decreased gradually with age, while in females, there was a sharp decrease in vBMD after the age of 40 years. At age of 31-40 years, vBMD was higher in females (P < 0.002), while at age > 60 years, vBMD was higher in males (61-70 years, P < 0.01; > 70 years, P = 0.02).Conclusions: We found significant age and gender differences in lumbar BMAT and vBMD. These findings will help to improve our understanding of the interaction between bone marrow fat content and bone mineral density in the ageing process.

Objective:To investigate the functions of monocyte chemotactic protein-induced protein 4 (MCPIP4) in human papillary thyroid cancer cell line TPC-1.Methods:TPC-1 cells were transfected with GFP-tagged MCPIP4 by Tet-on inducing expression system. Endogenous MCPIP4 was knocked down by stable expressing shRNA. MTT assay was performed to measure the growth of TPC-1 cells after overexpression or knockdown of MCPIP4. FACS method was used to analysis cell cycle in TPC-1 cells. Real-time PCR was used to test the expression of cell cycle-related mRNAs expression and their half-life. RNA-IP experiment was conducted to detect the mRNA directly enriched by MCPIP4. Luciferase assay was performed to determine whether the mRNA decay was mediated through 3′UTR.Results:The expression of MCPIP4 mRNA in papillary thyroid carcinoma cell line TPC-1 was significantly lower than that in normal thyroid tissue; MCPIP4 overexpression inhibited cell proliferation significantly ( P<0.05), while knockdown MCPIP4 promoted cell proliferation with statistical significance ( P<0.05). MCPIP4 induced cell cycle arrest in TPC-1 with statistical significance ( P<0.05). MCPIP4 overexpression reduced the half-life of cell cycle mRNAs (CDK4, CDK6, Cyclin D1, Cyclin E1, respectively) with significance (all P<0.01). In addition, cell cycle-related mRNAs were able to be pulled down by GFP-MCPIP4 but not by isotype IgG ( P<0.05). Compared with control vector, MCPIP4 significantly suppressed luciferase activities of all four 3′UTR reporters ( P<0.05). Conclusion:MCPIP4 can function as a tumor suppressor in human papillary thyroid cancer cell line TPC-1 through inducing G1 cell cycle arrest.

目的 总结成骨不全症(osteogenesis imperfecta,OI)成人患者的临床症状、骨转换、骨密度特征.方法 纳入2010 年至2023 年在北京积水潭医院内分泌科诊断的33 例成人OI患者,回顾性分析不同临床分型OI患者的特点,包括骨转换生化指标血清Ⅰ型胶原交联羧基末端肽(C-terminal telopeptide of type Ⅰcollagen,CTX)、血清Ⅰ型原胶原氨基端前肽(procollagen type Ⅰ N-prepeptide,P1NP)、N-端骨钙素(osteocalcin,OC)、25 羟维生素D(25-hydroxyvitamin D,25OHD),以及临床表型评分、成年后骨折、体积和面积骨密度(bone mineral density,BMD)等.结果 33 例成人OI患者中,约 3/4 为Ⅰ型和Ⅳ型,94%有脆性骨折史,普遍存在骨痛、维生素D缺乏(64%)或维生素D不足(91%);83%绝经前女性和 50 岁以下男性OI患者的BMD Z值≤-2 SD,89%绝经后女性和 50 岁以上男性患者的BMD T值≤-2.5 SD.成人Ⅲ型OI患者的临床表型评分最高(Ⅰ型 5.4±0.8、Ⅲ型 12.3±1.6、Ⅳ型 7.3±1.8,P＜0.001)、身高Z值最低(Ⅰ型0.02±0.8、Ⅲ型-4.0±1.4、Ⅳ型-1.9±1.1,P＜0.001)、体质量指数最高[Ⅰ型(22.4±3.1)kg/m2、Ⅲ型(25.8±2.1)kg/m2、Ⅳ型(22.6±3.8)kg/m2,P=0.049];更多出现骨骼畸形、活动受限和牙齿异常;股骨颈和全髋面积BMD Z值显著低于Ⅰ、Ⅳ型,但骨转换生化指标P1NP、OC、CTX及空腹血糖、总胆固醇、三酰甘油、尿酸比较,差异无统计学意义(P＞0.05).结论 成人OI患者普遍存在骨痛、超重、维生素D营养状况差、腰椎和髋部骨量低下,提示极高骨折风险;胶原代谢异常、活动减少、增龄和绝经相关骨量丢失在成人OI共同发挥作用.OI是导致成人继发性骨质疏松症的重要遗传性病因.

Phosphaturic mesenchymal tumor (PMT) is a rare, slowly progressive, histomorphologically distinct entity of tumors that can emerge anywhere in the body.[1] According to World Health Organization, PMT has two pathological types: benign and malignant.[2] PMT was discovered due to tumor-induced osteomalacia (TIO) and is increasingly accepted in recent years as the leading cause of TIO.[1] However, most published reports have focused on the clinicopathological, immunohistochemical, and molecular genetic studies on PMT rather than the radiological work-ups.[3,4] Hence, the aim of this study was to find the common imaging characteristics of PMT to assist clinical diagnosis. The radiology and pathology databases of Beijing Jishuitan Hospital were retrospectively reviewed for pathologically proven PMT. A total of 25 patients were initially retrieved. Among them, four patients were excluded because the lesions were postoperative tumor relapse or metastasis, and three patients were excluded for incomplete radiological data. Finally, 18 primary cases were included. A total of 18 PMTs from 18 patients (10 males, 8 females) were reported in this study. The average age at the time of hospital visit was 37.3 ± 16.3 years (range: 3.0–58.0 years). The clinical features are described in Supplementary Table 1, https://links.lww.com/CM9/B428. One patient in routine physical examination did not show any discomfort. Symptoms of osteomalacia were observed in 5/18 patients, while the remaining presented focal pain (n = 10), focal lump (n = 2), and shortening of the finger (n = 1) owing to the tumor lesions. The median duration from symptom onset to pathological diagnosis of PMT with and without osteomalacia symptoms were 24.75 months (0–9.8 years) and 5.75 months (0.8–27.0 years), respectively. All tumors were pathologically benign. Two lesions recurred at 29.0 months and 39.5 months after surgery, respectively. All laboratory values were obtained within 1 month of the imaging scan. The results showed that 9/18 patients had hypophosphatemia, of whom five had low serum calcium parameters. Additionally, 3/18 patients had elevated alkaline phosphatase levels, and 4/5 patients had low serum 25(OH)VitD3 levels (10.78 ± 4.59 ng/dL, range: 6.66–16.33 ng/mL, normal value: 20.00–40.00 ng/mL). Moreover, 2/6 patients had elevated full-length parathyroid hormone levels (90.15 pg/mL, range: 71.00–109.30 pg/mL, normal value: 15.00–65.00 pg/mL). Signs of osteomalacia, such as obscure or disappeared trabecular structures, insufficiency stress-type fractures (n = 3), and deformities in thoracic cage, spine, pelvic, and lower extremities, were observed in five patients. For anatomical imaging analysis, the lesions were divided into those originating from bone (n = 15), soft tissue (n = 2), and sinuses (n = 1). Fifteen lesions arose from bone with 9 (ilium [n = 7] and spine [n = 2]) from axial skeleton and 6 (femur [n = 2], metacarpus [n = 2], scapula [n = 1], and tibia [n = 1]) from appendicular skeleton. The mean maximal lesion diameter was 5.77 ± 2.74 cm (range: 2.65–10.90 cm). Additionally, 13/15 lesions showed a narrow zone of transition with partial sclerotic boundary, bony shell in 11/13, and 1/13, respectively (Figure 1A). All 15 lesions had partial cortical bone abruption, while 3/15 had extraosseous soft tissue components. The pathological fracture caused by the tumor was observed in 3/15 lesions. A total of 14 patients underwent CT (computed tomography) examinations, among whom 13 were evaluated by contrast CT. All 14 patients had osteolytic lesions with slight and obvious expansions in 5 and 3 cases, respectively. Calcification was observed in 10/14 lesions, and 4/10 exhibited a substantial phenotype [Figure 1A]. Ground glass density and fat density were observed in 7/14 and 5/14 lesions, respectively. The enhancement pattern characterised by obviously even, obviously uneven, intermediately uneven, and slightly uneven were seen in 1/13, 8/13, 3/13, and 1/13 cases, respectively. Furthermore, eight patients underwent plain and contrast MRI (nuclear magnetic resonance) examinations. Consequently, 6/8 lesions were heterogeneous on T1-weighted imaging, while 1/8 was slightly hypointense and 1/8 was iso-intense [Figure 1B]. All lesions were heterogeneous on T2-weighted imaging. Also, cystic changes, intratumoral bleeding, internal fluid–fluid level, and perilesional edema were detected in 2, 2, 1, and 2 lesions, respectively. Dark T2 was present in 7 lesions, with 5 corresponding to calcification or ground glass density observed on CT scan [Figure 1C]. All eight patients showed obvious enhancement after IV gadolinium injection (7 heterogeneous and 1 homogeneous). Two patients underwent dynamic contrast-enhanced MRI, and both time-signal intensity curves demonstrated a platform pattern.Figure 1: A 34-year-male with a PMT in the right acetabulum. The lesion demonstrates osteolytic bone destruction, slight expansion, obviously partial sclerotic margin, partial cortical bone abruption, patchy ground glass density and substantial calcification (A), corresponding to the large amount of dark signal on both T1WI and T2WI (B and C). Bone scintigraphy shows a positive uptake (D). PMT: Phosphaturic mesenchymal tumor; T1WI: T1-weighted imaging; T2WI: T2-weighted imaging.Two lesions arose from soft tissue with one in the upper arm and the other in the trunk. The mean maximal diameter was 1.83 cm (range: 1.71–1.95 cm). Both lesions showed even density with clear margin on plain CT scan, and obvious even enhancement on contrast scan. One of the lesions invaded into the adjacent bone. One lesion arose from sinuses invading into the left frontal sinus, left maxillary sinus, and left orbit. The maximal diameter of the lesion was 6.38 cm. It had a clear margin but involved the adjacent bony structure. Also, a lot of fat density was observed. It was uneven and distinctly uneven on plain and contrast CT scan, respectively, and heterogeneous on T1WI (T1-weighted imaging) and T2WI (T2-weighted imaging). The results showed that 9/12 lesions revealed an increased bone uptake by bone scintigraphy [Figure 1D], 1/1 lesion showed hypermetabolic characteristics by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT), and 1/1 lesion with octreotide scanning showed a positive uptake in the tumor location. The current study emphasized the under-recognition of non-phosphaturic PMT by the fact that only 5/18 patients presented with symptoms of osteomalacia. This cohort confirmed that PMT might have some unique features. Typically, all lesions were monostotic, and the density or signal was usually homogeneous if it was small (as our two lesions originated from soft tissues), which became inhomogeneous with growth. For tumors arising from bone, the lesions were osteolytic, sometimes with expansion and a component of fat, and most of them demonstrated variable amounts of ground glass density, foci of cartilage, or ossification on CT, corresponding to dark T2WI signal on MR, related to the pathological grungy and flocculent calcification. They sometimes demonstrate insufficiency fracture, caused by the hypocalcemia secondary to hypophosphatemia. These phenomena were consistent with those observed previously.[5] Also, there are some contradictions about the growth pattern. Interestingly, our lesions tended to display a narrow zone of transition with well-formed and sometimes sclerotic margins (even nearly complete bony shell in one lesion), suggesting a slow process and non-aggressive nature. On the other hand, all lesions had interrupted cortical bone, some of which were associated with intralesional hemorrhage and internal fluid–fluid levels, suggesting rapid growth. These phenomena in addition to soft tissue lump and perilesional edema that stood for histological focal invasiveness indicated aggressive biological behavior. For the tumor in sinuses, we found no grungy calcifications but salient lipid components. Other studies showed similar findings,[1] indicating that this feature might be crucial for sinonasal PMT. In conclusion, PMT may have some common features. The combination of imaging and clinical features can improve the accuracy of diagnosis. However, more cases still need to be investigated. None. Funding The study was funded by grants from the Beijing Bureau of 215 Program (No. 2013–3-033; 2009–02-03). Conflicts of interest None.

PurposeCurrently, endoscopic transsphenoidal surgery (ETS) and microscopic transsphenoidal surgery (MTS) are commonly applied treatments for patients with pituitary adenomas. This meta-analysis was conducted to evaluate the efficacy and safety of ETS and MTS for these patients.MethodsA computer search of Pubmed, Embase, Cochrane library, Web of Science, and Google Scholar databases was conducted for studies investigating ETS and MTS for patients with pituitary adenomas. The deadline is March 01, 2021. RevMan5.1 software was used to complete this meta-analysis after literature screening, data extraction, and literature quality evaluation.ResultsA total of 37 studies including 5,591 patients were included. There was no significant difference in gross tumor removal (GTR) and hormone-excess secretion remission (HES remission) between two groups [RR = 1.10, 95% CI (0.99–1.22), P = 0.07; RR = 1.09, 95% CI (1.00–1.20), P = 0.05]. ETS was associated with lower incidence of diabetes insipidus (DI) [RR = 0.71, 95% CI (0.58–0.87), P = 0.0008], hypothyroidism [RR = 0.64, 95% CI (0.47–0.89), P = 0.007], and septal perforation [RR = 0.32, 95% CI (0.13–0.79), P = 0.01] than those with MTS.ConclusionThis meta-analysis indicated that ETS cannot significantly improve GTR and HES remission. However, ETS could reduce the incidence of DI, hypothyroidism, and septal perforation without increasing the rate of other complications.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42021241217.

Background Although insulin pump therapy is an important treatment modality for patients with type 1 diabetes, rates of pump use appear to vary broadly internationally. This study aimed to investigate the application of insulin pump therapy among patients with type 1 diabetes in China. Methods Data were collected from the Type 1 Diabetes Mellitus in China: Coverage, Costs and Care Study (3C Study). A total of 779 participants from this cross-sectional study were included. Multivariable logistic regression was used for data analysis. Results The median (interquartile range) age at diagnosis of diabetes was 17 (10–28) years and the duration of diabetes was 4 (1–8) years. Among 779 patients, only 89 patients (11.4%) used an insulin pump to control blood glucose. A statistically significant difference was found in HbA1c favoring insulin pump therapy (8.3 ± 1.7% vs. 9.2 ± 2.6%) without obvious differences for severe hypoglycaemia. There were higher proportions of patients with no smoking, frequent daily intake of fruits and vegetables, and adequate self-blood glucose monitoring among patients with insulin pump therapy as compared to those using multiple daily insulin injections. Logistic regression analysis showed that younger age at diagnosis, longer duration of diabetes, higher education level of family members, and higher household income were associated with the use of an insulin pump. Conclusions Data from 3C Study demonstrated that only a minority of patients with type 1 diabetes in China utilize insulin pump therapy. Insulin pump therapy was associated with better blood glucose control and self-management. Patients with younger age at diagnosis and longer duration of diabetes, and patients with better socioeconomic status were more likely to use an insulin pump.

PurposeProlactin (PRL) exerts actions in the bone besides lactation and reproduction. This study aimed to investigate whether PRL is related to bone mineral density (BMD) in type 2 diabetes mellitus (T2DM).MethodsA total of 642 patients with T2DM were divided into two groups with age and body mass index (BMI) matched: mildly increased PRL (HP group, n = 101) or normal PRL (NP group, n = 541). BMD was measured by dual-energy X-ray absorptiometry and compared.Results1) BMD, T score at lumbar spine L1–4, right hip and femur neck, and Z score at the femur neck were significantly higher in the HP than in the NP group (0.96 ± 0.16 vs. 0.92 ± 0.15g/cm2, p = 0.019; 0.88 ± 0.15vs. 0.84 ± 0.14 g/cm2, p = 0.007; 0.75 ± 0.17 vs.0.70 ± 0.13 g/cm2, p = 0.001; -0.90 (-1.85, -0.20) vs. -1.40 (-2.20, -0.40), p = 0.018; -0.80 (-1.50, -0.30) vs. -1.10 (-1.80, -0.53), p = 0.026; -1.30 (-2.00, -0.60) vs. -1.70 (-2.20, -1.00), p = 0.001; -0.20 (-0.70, 0.30) vs. -0.40 (-0.90, 0.10), p = 0.026). In men, T and Z scores at the right hip and femur neck were significantly higher in the HP than in the NP group (-0.70 (-1.32, 0.20) vs. -0.90 (-1.50, -0.40), p = 0.038; -0.20 (-0.80, 0.20) vs. -0.50 (-0.10, 0.10), p = 0.027; -0.30 (-0.60, -0.30) vs. -0.40 (-0.90, 0.20), p = 0.038) but not in women. Bone turnover markers have no significant difference between groups (all p > 0.05). 2) BMD at the right hip and Z score at the right hip and femur neck were significantly positively associated with PRL (r = 0.087, p = 0.029; r = 0.089, p = 0.024; r = 0.087, p = 0.029). In men, BMD at L1–4 and the right hip; T score at L1–4, the right hip, and the femur neck; and Z score at the right hip and the femur neck were significantly positively associated with PRL (r = 0.122, p = 0.007; r = 0.105, p = 0.041; r = 0.123, p = 0.016; r = 0.110, p = 0.032; r = 0.115, p = 0.025; r = 0.121, p = 0.018; r = 0.138, p = 0.007) but not significant in women. 3) In men divided into two groups according to T score (T score at the right hip>-1 or T score at the right hip≤-1) or the median BMD at L1–4, the right hip or the femur neck, PRL was significantly higher in the higher BMD than in the lower BMD group (16.32 ± 6.12 vs. 14.78 ± 5.68 ng/ml, p = 0.012; 16.20 ± 6.21 vs. 14.73 ± 5.40 ng/ml, p = 0.014; 16.10 ± 6.01 vs. 14.80 ± 5.77 ng/ml, p = 0.032; 16.17 ± 6.04 vs. 14.76 ± 5.77 ng/ml, p = 0.02; 16.48 ± 6.05 vs. 14.98 ± 5.81 ng/ml, p = 0.020; 16.10 ± 5.98 vs. 14.80 ± 5.87 ng/ml, p = 0.035).ConclusionIncreased PRL was associated with better BMD in patients with T2DM, especially in men. PRL within the biologically normal range may play a protective role in the BMD of T2DM.

Objective:To analyze the clinical and pathological features of asymptomatic primary hyperparathyroidism (PHPT) .Methods:A retrospective analysis was carried out in terms of the clinical characteristics and pathological data in 30 patients with asymptomatic PHPT and 86 patients with typical PHPT hospitalized in the Department of Endocrinology and General Surgery of Beijing Jishuitan Hospital from Jan. 2013 to Dec. 2018. There were 7 males (23.3%) and 23 females (76.7%) , with a male to female ratio of 1:3.3. The average age was 56.9±13.3 years. In typical PHPT group, there were 32 males (37.2%) and 54 females (62.8%) , with the average age of 46.4±17.0 years. Bone metabolism indicators included bone density and bone biochemical markers (parathyroid hormone, 25-hydroxyvitamin D and alkaline phosphatase) . The t test was used to compare normally distributed variables, the Mann-Whitney rank sum test was used to compare skewed distributed variables, and the χ 2 test was used to compare enumeration data. Results:The median serum parathyroid hormone and alkaline phosphatase were 144.2 (108.1, 207.0) pg/ml and 80.0 (53.7, 105.5) IU/L respectively, the average serum concentration of calcium was 2.80±0.20 mmol/L, which were significantly lower than those of the classic group ( P<0.05) . The median serum 25-hydroxyvitamin D was 12.14 (7.87, 14.38) ng/ml, which was higher than that of the classic group ( P<0.001) . Ten patients (33.3%) developed osteoporosis, and the incidence was lower than that of the classic group ( P< 0.001) . The median tumor weight was 0.80 (0.25, 1.98) g, significantly smaller than that in the classical group ( P=0.003) . There were 26 cases (86.7%, including 2 atypical parathyroid adenomas) of parathyroid adenomas and 4 cases (13.3%) of hyperplasia. Conclusions:The asymptomatic PHPT has the same sex ratio as the classic type, mainly female, but the average age is significantly higher than that in the classic type. Although asymptomatic PHPT in this study are all benign lesions, abnormal bone biochemical indicators, especially vitamin D deficiency, are common, which also lead to osteoporosis.

Objective:To compare the efficacy and safety of continuous subcutaneous insulin analogues infusion (CSII) and multiple daily insulin analogues injection (MDII) in fracture patients with type 2 diabetes mellitus (T2MD) during the perioperative period.Methods:The medical data of patients with lower limb fracture complicated with T2MD in Beijing Jishuitan Hospital from 2017 to 2021 were collected by hospital information system and analyzed retrospectively. The medical data of patients extracted included gender, age, body weight, body mass index (BMI), fracture site, pain score and grading, time from fracture to admission, duration of T2MD, laboratory test results at admission, blood glucose control regimen and monitoring result after admission, and the adverse events. Patients were divided into CSII group and MDII group according to blood glucose control regimen during the perioperative period. The clinical features, time to reach target blood glucose range, insulin application, and adverse events in patients of the 2 groups were compared.Results:A total of 207 patients were enrolled in this study, including 90 males and 117 females, aged (61±15) years with BMI of (25.5±3.5) kg/m 2. No significant differences were found in gender, age, BMI, fracture site, pain score and grading, time from fracture to admission, duration of T2MD, and laboratory test resurts at admission in patients between the 2 groups (all P>0.05). Patients in the CSII group had shorter time to reach target range of fasting blood glucose, 2-h postprandial blood glucose, and the both than those in the MDII group [(48.7±30.2) h vs. (78.7±44.5) h, P=0.003; (66.8±31.5) h vs. (93.3±47.6) h, P=0.001; (68.4±30.5) h vs. (96.3±48.1) h, P<0.001]. The total daily dose and total pre-prandial dose of insulin per unit weight in patients when the fasting and 2-h postprandial glucose both reach the target range were less in the CSII group than those in the MDII group [(0.67±0.20) U/kg vs. (0.73±0.17) U/kg, P=0.030; (0.34±0.10) U/kg vs. (0.38±0.09) U/kg, P=0.004]. In 207 patients, hypoglycemia occurred in 17 patients for 23 times with an overall incidence of 8.2%(17/207). The difference in the incidence of hypoglycemia was not significant between the 2 groups [4.9%(5/102) vs. 11.4%(12/105), P=0.319]. None of the 5 patients with hypoglycemia in the CSII group had hypoglycemia for 2 times or more, while 4 of the 12 patients in the MDII group had 2 times of hypoglycemia and 1 had 3 times of hypoglycemia. Other adverse drug events included allergy, systemic edema, nodular hyperplasia of subcutaneous fat, and persistent bleeding at the injection site. Eight patients in the CSII group had other adverse events, including device failure in 5 patients, and using insulin pump during anesthesia, in magnetic field environment, and in humid environment in 3 patients respectively. Conclusions:CSII regimen is helpful for fracture patients with T2DM to achieve target blood glucose range earlier, and provides more ways and opportunities to correct hypoglycemia in patients. However, the insulin pump needs more professional maintenance in practice, so it has limitations to some extent in clinical application.

Background Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare disease characterized by hyperphosphatemia and ectopic calcification, predominantly at periarticular locations. This study was performed to characterize the clinical profile of tumoral calcinosis and to identify gene mutations associated with HFTC and elucidated its pathogenic role. Methods The three subjects (two male and one female) were aged 30, 25 and 15 years, respectively. The clinical features, histopathological findings, and outcomes of three subjects with HFTC were retrospectively reviewed. The three subjects were analyzed for FGF23, GALNT3 and KL mutations. Function of mutant gene was analyzed by western blotting and wheat germ agglutinin affinity chromatography. Results All subjects had hyperphosphatemia and elevated calcium-phosphorus product. Calcinosis positions included the left shoulder, left index finger, and right hip. Bone and joint damage were present in two cases and multiple foci influenced body growth in one case. The histopathological features were firm, rubbery masses comprising multiple nodules of calcified material bordered by the proliferation of mononuclear or multinuclear macrophages, osteoclastic-like giant cells, fibroblasts, and chronic inflammatory cells. The novel mutation c.484A>G (p.N162D) in exon 3 of FGF23 was identified in one subject and his family members. Measurement of circulating FGF23 in the subject confirmed low intact FGF23 and increased C-terminal fragment. In vitro experiments showed that the mutant FGF23 proteins had defective O-glycosylation and impaired protein proteolysis protection. Conclusion We identified a novel FGF23 missense mutation, and confirmed its damaging role in FGF23 protein O-glycosylation. Our findings expand the current spectrum of FGF23 variations that influence phosphorus metabolism.

RNA-binding protein (RBP) plays an important role in the pathogenesis of thyroid cancer. It can regulate the intracellular activities such as transcription, nuclear output, alternative splicing and translation of mRNA from tumor-related genes at the post-transcriptional or translation levels, and then regulate the proliferation, apoptosis and migration of thyroid cancer, thereby promoting or inhibiting the occurrence of tumors. Clinically, a series of RBP molecules are significantly correlated with the classification and prognosis of patients with thyroid cancer and may support the oncological classification, evaluation and prediction of prognosis of thyroid cancer.

Background Venous thromboembolism (VTE) is a significant complication after joint arthroplasty. Diabetes is related to a few changes in coagulation and fibrinolysis that may lead to thrombophilia. We aimed to investigate the incidence of postoperative VTE and associated risk factors among patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single centre in China. Methods Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 ( n = 400) at Beijing Jishuitan Hospital were recruited in this study. Lower limb venous Doppler ultrasound was performed before and after surgery to confirm deep venous thrombosis (DVT). Computer tomography pulmonary angiography was done to confirm pulmonary embolism (PE) for those with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was conducted to examine factors associated with the development of postoperative VTE. Results The overall incidence of postoperative VTE in patients with diabetes after THA or TKA was 46.8 % (187 out of 400). Among the 187 VTE patients, 7.5 % (14 out of 187) had proximal vein thrombosis and 92.5 % (173 out of 187) had distal vein thrombosis. No PE occurred. Female patients and patients undergoing TKA had higher incidence of postoperative VTE. Patients who developed postoperative VTE were older, and had higher levels of preoperative D-Dimer and Caprini score. A high level of preoperative D-dimer (OR = 2.11, 95 %CI = 1.35–3.30) and the surgery of TKA (OR = 2.29, 95 %CI = 1.29–4.01) significantly increased the risk of developing postoperative VTE. Postoperative initiation of concomitant mechanical prophylaxis and low molecular weight heparin (LMWH) was protective for postoperative VTE (OR = 0.56, 95 %CI = 0.37–0.86). Conclusions VTE is common in patients with diabetes undergoing joint arthroplasty. Patients undergoing TKA or with a high level of preoperative D-dimer are at a considerable risk of developing postoperative VTE. There may be a protective role of postoperative initiation of concomitant mechanical prophylaxis and LMWH for VTE.

目的 研究口服阿仑膦酸钠维D3或单次肌肉注射维生素D2预处理对首次静脉注射唑来膦酸治疗骨质疏松症发生急性时相反应的影响.方法 选取绝经后骨质疏松症患者97例,随机纳入口服阿仑膦酸钠维D3处理组(阿仑组,33例)、单次肌肉注射维生素D2组(VD2组,31例)、无预处理组(对照组,33例),比较分析3组的临床资料、基线指标及静脉注射唑来膦酸前后血常规、生化指标及72 h内急性时相反应发生率.采用多元Logistic回归分析探讨发热与血常规、 生化指标、 骨转换指标的相关性.结果 3组患者年龄、 体重及基线血常规、生化指标均无明显差异(均P>0.05).单因素方差分析(One-way ANOVA)对比三组患者静脉注射唑来膦酸前后血常规及生化指标,VD2组及阿仑组中性粒细胞/淋巴细胞比值(neutrohpil to lymphocyte ratio,NRL)均小于对照组,差异均有统计学意义(P<0.05).静脉输注唑来膦酸后72 h内对照组、VD2组、阿仑组急性时相反应发生率分别为:发热(81.8％,74.2％,41.9％)、乏力(45.5％,9.7％,12.9％)、头痛(60.6％,19.4％,6.5％)、头晕(21.2％,9.7％,0％)、骨痛(69.7％,45.2％,16.1％)、关节痛(54.5％,6.5％,12.9％)、肌肉痛(63.6％,38.7％,22.6％)及恶心(15.2％,3.2％,0％),差异均有统计学意义(均P<0.05),VD2组及阿仑组上述症状发生率均较对照组低.经Pearson相关性分析发现发热与用药前总I型前胶原氨基端延长肽(total procollagen type 1 amino-terminal propeptide,tP1NP)及I型胶原羧基端肽β特殊序列(β-isomerized C-terminal telopeptide of type I collagen,β-CTX)呈显著正相关(相关系数分别为0.28和0.29,P均<0.05),与25羟维生素D[25-OH vitamin D,25(OH)D]呈显著负相关(相关系数为-0.36,P<0.05).多元Logistic回归分析表明用药前血清25(OH)D低水平为用药后发生发热的危险因素[OR=0.86(95％CI:0.72～0.90),P=0.04].结论 阿仑膦酸钠维D3及维生素D2预处理均可有效缓解首次静脉注射唑来膦酸出现的急性时相反应,用药前血清25(OH)D低水平可作为静脉注射唑来膦酸后发热的危险因素.