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Metabolic diseases, such as diabetes, gout and hyperlipidemia are global health challenges. Among them, diabetes has been extensively investigated. Type 2 diabetes mellitus (T2DM), which is characterized by hyperglycemia, is a complex metabolic disease that is associated with various metabolic disorders. The newly developed oral hypoglycemic agent, sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been associated with glucose-lowering effects and it affects metabolism in various ways. However, the potential mechanisms of SGLT2 inhibitors in metabolic diseases have not fully reviewed. Many of the effects beyond glycemic control must be considered off-target effects. Therefore, we reviewed the effects of SGLT2 inhibitors on metabolic diseases such as obesity, hypertension, hyperlipidemia, hyperuricemia, fatty liver disease, insulin resistance, osteoporosis and fractures. Moreover, we elucidated their molecular mechanisms to provide a theoretical basis for metabolic disease treatment.

Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations are common for calculating estimated glomerular filtration rate (eGFR). Unlike CKD, the key pathological change of diabetic kidney disease (DKD) is glomerulosclerosis. Methods To conduct a meta-analysis of the diagnostic performance of the CKD-EPI and MDRD equations in diabetic patients, we searched PubMed, Embase and the Cochrane Library for studies comparing standard GFR (sGFR) with eGFR using these two equations. Results Thirteen studies of 7192 diabetic patients reporting data on bias or accuracy were included. At the study level, both equations underestimated eGFR. CKD-EPI was more accurate in studies with mean GFR ≥60 mL/minute/1.73 m2. At the individual level, both equations overestimated GFR by 6.38 mL/minute/1.73 m2 (95% confidence interval [CI] 2.67–10.1) and 7.65 mL/minute/1.73 m2 (95% CI 2.78–12.52), respectively, for sGFR 2. The CKD-EPI equation was 7.61% (95% CI 4.66–10.56) more accurate in subjects with sGFR > 90 mL/minute/1.73 m2. The CKD-EPI equation performed poorly in diabetic patients. Conclusions The CKD-EPI equation can be used to estimate GFR in patients with incipient DKD, but has drawbacks. Improved eGFR equations suitable for diabetic populations are needed.

Purpose: To investigate the role of vagus nerve activation in the protective effects of hypercapnia in ventilator-induced lung injury (VILI) rats. Methods: Male Sprague-Dawley rats were randomized to either high-tidal volume or low-tidal volume ventilation (control) and monitored for 4h. The high-tidal volume group was further divided into either a vagotomy or sham-operated group and each surgery group was further divided into two subgroups: normocapnia and hypercapnia. Injuries were assessed hourly through hemodynamics, respiratory mechanics and gas exchange. Protein concentration, cell count and cytokines (TNF-α and IL-8) in bronchoalveolar lavage fluid (BALF), lung wet-to-dry weight and pathological changes were examined. Vagus nerve activity was recorded for 1h. Results: Compared to the control group, injurious ventilation resulted in a decrease in PaO2/FiO2 and greater lung static compliance, MPO activity, enhanced BALF cytokines, protein concentration, cell count, and histology injury score. Conversely, hypercapnia significantly improved VILI by decreasing the above injury parameters. However, vagotomy abolished the protective effect of hypercapnia on VILI. In addition, hypercapnia enhanced efferent vagus nerve activity compared to normocapnia. Conclusion: These results indicate that the vagus nerve plays an important role in mediating the anti-inflammatory effect of hypercapnia on VILI.

In the context of the development of medical science and the transformation of medical models, higher requirements are placed before physicians with respect to comprehensive quality. Training for comprehensive quality requires strengthening of medical education. In the current training environment, it is difficult for traditional medical colleges and universities to meet this demand. Our school takes an approach that places the medical students at the center. We are conducting research on strategies and methods of the practical teaching model called “health management for relatives and friends (HMRF).” This entails managing the health of medical students’ relatives and friends, establishing a network platform, and organically combining the network platform with traditional teaching. After 6 years of exploration and implementation, medical students effectively improved their autonomous learning abilities and augmented occupational qualities such as clinical thinking, doctor-patient communication, information collection, and clinical decision-making. They did this by role-playing, practicing progressive humanistic care, and transferring educational practice to clinical practice. Practical teaching of health management for relatives and friends is a new, effective, and simple training model to enhance multidimensional qualities of medical students.

Introduction Rotigaptide is a new anti-arrhythmic peptide, which has recently been found to increase junctional conductance and prevent ischemia-induced ventricular tachycardia. In this study, we attempted to investigate the effects and mechanisms of rotigaptide on the vulnerability to ventricular arrhythmias in rabbits with heart failure (HF). Material and methods Chronic volume-pressure overload was used to induce HF. After rotigaptide infusion, an electrophysiological study was performed to record monophasic action potential (MAP), determine the effective refractory period (ERP) and ventricular fibrillation threshold (VFT), and assess the susceptibility to ventricular arrhythmia. Finally, real-time PCR was used to detect the changes of connexin 43 (Cx43) mRNA expression. Results HF rabbits exhibited significant down-regulation of Cx43 mRNA, increase of effective refractory period (ERP) and decrease of VFT (p < 0.05, respectively). These changes resulted in an increase of vulnerability to ventricular tachyarrhythmias (VT/VF). Rotigaptide administration shortened ERP (113.3 ±8.6 ms vs. 131.7 ±12.5 ms, p < 0.05), restored VFT (15.0 ±2.0 V vs. 6.3 ±1.4 V, p < 0.05), and decreased the vulnerability to VT/VF. However, short-term rotigaptide treatment had no significant effect on MAP duration (MAP duration at 90% repolarization: 169.3 ±6.0 ms vs. 172.7 ±6.2 ms, p > 0.05) or connexin 43 mRNA expression (p > 0.05). Conclusions Rotigaptide decreases the ERP, elevates VFT, and reduces the vulnerability to ventricular arrhythmias without changing Cx43 expression in rabbits with HF. It may be a promising antiarrhythmic drug for preventing ventricular arrhythmia in HF.

To evaluate the effect of estrogen on its ability to restore the bone mass and bone quality in ovariectomized rats by examining the changes of bone morphology and histomorphometry, 3-month-old rats were divided randomly into 4 groups: normal control, ovariectomized (OVX), shamoperated (Sham-O) and OVX plus estrogen (OVX+E2). Treatment initiated from the day 8 weeks after operation and continued for 12 weeks. Bone morphology and histomorphometry were examined afterwards. Results showed that comparing to control group, the trabecular bone in OVX appeared thinner and reduced in the amount. The connectivity between trabecula was decreased and the structure disordered. The free-end of trabecula was increased. The cavity of bone marrow enlarged. After treatment with estrogen, above changes improved remarkably by different degree, although did not reach the normal face. The bone histomorphometry results damonstrated that estrogen treatment increased bone mass and the amount of trabecula by 129 % and 132 % respectively (P < 0. 05). The activity of bone resorption decreased significantly and the rate of bone formation increased to 203%. These results suggest that treatment of ovariectomized rats with estrogen can not only increase bone mass, also improve the bone structure and enhance the property of bone mechanics.