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<p><b>OBJECTIVE</b>A new technique of transthoracic lung ultrasonography (TLS) has emerged and demonstrated promising results in acute heart failure diagnosis at an early stage. However, the diagnostic value of ultrasound lung comets (ULCs) for acute heart failure (AHF) performed in busy emergency department (ED) is uncertain. The present meta-analysis aimed to assess the diagnostic efficiency of ULCs in AHF.</p><p><b>METHODS</b>We conducted a search on online journal databases to collect the data on TLS performed for diagnosing AHF published up to the end of July 2017. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and summary receiver operating characteristic (SROC) curve were calculated. The post-test probability of AHF was calculated by using Bayes analysis.</p><p><b>RESULTS</b>We enrolled a total of 15 studies involving 3,309 patients. The value of sensitivity, specificity, PLR, NLR, DOR, area under the SROC curve, and Q* index was 85%, 91%, 8.94, 0.14, 67.24, 0.9587, and 0.9026, respectively. We detected significant heterogeneity among included studies, and therefore, all these results were analyzed under the random-effect model. We also explored possible sources of heterogeneity among the studies by using meta-regression analysis. Results suggest that the time interval between patient's admission to bedside TLS examination was closely related to TLS accuracy.</p><p><b>CONCLUSION</b>This meta-analysis demonstrated that detecting ULCs is a convenient bedside tool and has high accuracy for early AHF diagnosis in ED. TLS could be recommended to be applied for early diagnosis of AHF in ED.</p>
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Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.
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<p><b>OBJECTIVE</b>To investigate the changes in angiotensinogen (AGT), angiotensin II type 1 receptor (AT(1)R), endothelial nitric oxide synthase (eNOS) mRNA and protein expressions and nitric oxide (NO) content in the rat glomeruli in response to leptin stimulation.</p><p><b>METHODS</b>The glomeruli isolated from male SD rats were stimulated with 3 nmol/L leptin for 2 h. Real-time PCR and Western blotting were performed to analyze the mRNA and protein expressions of AGT, AT(1)R and eNOS in the glomeruli, and nitrite concentration in the glomeruli was measured by nitrate reductase assay.</p><p><b>RESULTS</b>In comparison with the control group, exposure to leptin increased the mRNA levels of AGT, ATR(1) and eNOS in the isolated glomeruli by 2.69-/+0.17, 3.77-/+0.16 and 2.56-/+0.29 folds (P=0.024, 0.018 and 0.044), and their protein levels by 2.06-/+0.10, 2.67-/+0.08 and 1.61-/+0.13 folds (P=0.021, 0.015 and 0.032), respectively. The NO production in the glomeruli was also increased by 2.77-/+0.14 folds (P=0.000) following leptin exposure.</p><p><b>CONCLUSION</b>Leptin exposure of isolated rat glomeruli directly causes activation of the internal renal renin-angiotensin system and enhanced NO production, suggesting that leptin plays a role in the pathogenesis of maladaptation in renal hemodynamics in obesity.</p>
Subject(s)
Animals , Male , Rats , Gene Expression Regulation , Kidney Glomerulus , Metabolism , Leptin , Pharmacology , Nitric Oxide , Nitric Oxide Synthase Type III , Genetics , Metabolism , RNA, Messenger , Genetics , Metabolism , Rats, Sprague-Dawley , Receptor, Angiotensin, Type 1 , Genetics , Metabolism , Renin-Angiotensin SystemABSTRACT
<p><b>OBJECTIVE</b>To investigate the renal protective effects of sulodexide and its anti-oxidative stress mechanism in diabetic rats.</p><p><b>METHOD</b>Thirty male SD rats were randomized into 3 equal groups, namely the control group, diabetic group, and sulodexide treatment group. Twelve weeks after establishment of rat diabetic models and administration of sulodexide, the rats were sacrificed for measurement of the urine volume, body mass, kidney mass/body weight ratio, plasma glucose, and glycosylated hemoglobin (HbA1c). Malondialdehyde (MDA) levels and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-PX) activities in the renal tissue or serum were tested. Electron microscopy was performed to observe the pathological changes in the kidneys.</p><p><b>RESULTS</b>The urine volume, renal mass/body mass ratio, serum glucose, HbA1C, and serum and renal MDA levels all significantly increased in the diabetic rats in comparison with the normal controls (P<0.05). But the body weight and activities of SOD, CAT, and GSH-PX in the renal tissue in the normal control group were significantly higher than those in the diabetic and sulodexide group. After 12 weeks of sulodexide treatment, SOD, CAT, and GSH-PX activities in the renal tissue of rats were significantly increased in comparison with those in the diabetic rats (P<0.05). Electron microscopy showed obvious irregular thickening of the glomerular capillary basement membrane in the diabetic group with vacuolization in the mitochondria in the epithelial cells, and such pathological changes were significantly alleviated in the sulodexide treatment group.</p><p><b>CONCLUSIONS</b>Sulodexide can effectively lower the urinary albumin excretion rate, improve the ultrastructural renal pathologies and prevent glomerular basement membrane thickening in diabetic rats, probably in association with the reduction of the MDA levels and enhancement of SOD, CAT, and GSH-PX activities.</p>
Subject(s)
Animals , Male , Rats , Antioxidants , Pharmacology , Therapeutic Uses , Body Weight , Catalase , Metabolism , Diabetes Mellitus , Drug Therapy , Metabolism , Pathology , Glutathione Peroxidase , Metabolism , Glycosaminoglycans , Pharmacology , Therapeutic Uses , Kidney , Metabolism , Pathology , Malondialdehyde , Metabolism , Organ Size , Rats, Sprague-Dawley , Superoxide Dismutase , MetabolismABSTRACT
A total of 126 patients with type 2 diabetes mellitus were randomized into two groups:one received glimepiride 1 mg twice daily and the other 2 mg once daily.Fasing blood glucose(BG),BG 2 h after meals(breakfast,lunch and dinner)and HbA_(IC)were tested,△and standard deviation of the 4 point BG were calculated.It was found that two kinds of administration of glimepiride were equally effective in decreasing BG and once daily aministration could ease better the fluctuation of BG.