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Objective To analyze the correlation between urinary albumin/creatinine ratio (ACR) and 24-hour urinary microalbumin (UMA) and evaluate the predictive value of ARC for early diabetic nephropathy.Methods A total of 368 patients with type 2 diabetes mellitus were retrospectively collected.Early diabetic nephropathy was defined as 24h UMA 30～＜300 mg/24h.The correlation between ACR and 24hUMA,and the area under the receiver operating characteristic (ROC) curve of ACR in diagnosis of early diabetic nephropathy were calculated.Gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol were used as adjusting variables to establish univariate and multivariate logistic models of ACR for early diabetic nephropathy,respectively.A regression model was used to evaluate the diagnostic value of ACR for early diabetic nephropathy.Results The correlation between ACR and 24h UMA was 0.658.The area under ROC curve of ACR for early diabetic nephropathy was 0.907 before and 0.933 after adjustments of gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol,respectively.The OR value of ACR of diabetic nephropathy was 2.016 before and 2.762 after same adjustments.The calibration of Hosmer-Lemeshow chi-square test evaluation model was 19.362 before (P=0.13) and 14.928 after adjustments (P=0.061).Conclusion ACR is a better predictor for early diabetic nephropathy although its value is influenced by gender,age,course of disease,blood sugar,lipid,and blood pressure.
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Objective Type 2 diabetes increases the risk of colorectal cancer and reduces the survival rate of the patients. Therefore, analyzing the characteristics of colorectal cancer in patients with type 2 diabetes may help to develop precise medical measures and to improve the prognosis of patients. Methods The pathological characteristics of 123 colorectal cancer cases with or without type 2 diabetes were analyzed. In addition, PCR and pyrosequencing method were used to test the common gene mutation status of colorectal cancer, including KRAS( codons 12, 13, 61, and 146) , BRAF( codon 600) , and PIK3CA ( exons 9 and 20) , in order to investigate the molecular characteristics of colorectal cancer in diabetic patients which may provide some clues to clinical decision. Results The mean age and body mass index of patients with diabetes were higher than those of patients without diabetes, but there was no difference in the location, the degree of cell differentiation and the grade of colorectal cancer between these 2 groups. The rate of PIK3CA mutation in patients with type 2 diabetes mellitus, especially in patients with long term type 2 diabetes was significantly higher than that in patients without diabetes (28.6％vs 10.3％, P<0.05). There was no significant difference between the two groups in common BRAF and KRAS mutation sites. Conclusion Diabetes does not alter the clinical pathological characteristics of colorectal cancer, but long course type 2 diabetes increases PIK3CA mutation rate. Therefore, using medicine targeting PIK3CA gene mutation may help to improve the prognosis of patients.
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Purpose To explore the preliminary application of spectral CT in the diagnosis of breast cancer,in order to provide more imaging supplemental information for clinical studies.Materials and Methods Twelve patients with pathologically confirmed breast cancer underwent preoperative spectral CT dual-phase contrast-enhanced scans in General Hospital of Lanzhou from May 2016 to February 2017 were retrospectively analyzed,including 6 patients with lymph node metastasis.With contralateral normal breast as the control group,the CT values at 40-140 keV,spectral curve slopes,iodine contents and relative iodine contents of breast cancer were measured in dual phase.The spectral curve,histogram,scatter plot of primary lesions and metastatic lymph nodes were drawn.In order to compare the radiation doses,12female patients undergoing dual-phase contrast-enhanced scans with traditional CT were included randomly as the control group,and the radiation dose evaluation parameters included volume CT dose index,dose-length product,effective dose.Results All the spectral parameters of breast cancer in arterial phase and venous phase were higher than those of normal breast,and the differences were statistically significant (P＜0.05).The average effective dose of spectral CT dual-phase contrast-enhanced scans was lower than that of regular CT,and the difference was statistically significant (P＜0.05).For the 6 patients with lymph node metastasis,the spectral curve,histogram and scatter plot of primary lesions and metastatic lymph nodes were in higher consistency in venous phase.Conclusion The special spectral parameters of breast cancer contribute to the further diagnosis of lesions.The consistence of spectral curve,histogram and scatter plot of primary lesions and metastatic lymph nodes is helpful for the identification of lymph nodes.Spectral CT breast dual-phase contrast-enhanced scans use lower radiation dose,which makes up for the deficiency of traditional CT in the qualitative diagnosis of breast diseases due to higher radiation dose.Therefore,spectral CT is of certain clinical application value in the diagnosis of breast cancer.
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Objective To observe the changes of serum and fecal taurine-conjugated bile acid levels and its association with glucose metabolism during the spontaneous development of type 2 diabetes in OLETO rats.Methods Twenty male OLETF rats(4 weeks old)were included and 10 male LETO rats of the same age were used as the normal control group.OLETF rats were fed with high fat diet whereas LETO rats were fed with normal diet.Serum and fecal taurine-conjugated bile acid levels of OLETF rats were tested at different stage of diabetes including baseline, normal glucose tolerance, impaired glucose tolerance and diabetes periods, and the association of taurine-conjugated bile acid level with body weight, blood glucose, and glucose-regulating hormones were also investigated.Results Compared with LETO rats, the baseline serum levels of taurine-conjugated bile acid in OLETF rats did not change, but the levels of fecal taurine-conjugated bile acid including taurine-conjugated chenodeoxycholic acid(TCDCA), taurocholic acid(TCA)and taurine-conjugated deoxycholic acid(TDCA)were significantly decreased [(14.25±7.18 vs 0.90±0.31)mg/kg,(7.12±4.14 vs 1.30±0.35)mg/kg,(4.30±1.78 vs 1.02±0.14)mg/kg, all P<0.01].During the development of diabetes, the fecal levels of TCDCA, TCA and TDCA were still lower than those in the control rats.TDCA was negatively associated with the level of fasting blood glucose(r=-0.470, P=0.032),but positively associated with the serum level of glucagon-like peptide(GLP)-l(r=0.406, P=0.044).Conclusion The decrease of intestinal taurine-conjugated bile acid level is involved in the development of diabetes in OLETF rats.Intestinal TDCA may regulate the secretion of GLP-1 by paracrine pathway.
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Objective To study the infection situation of methicillin‐resistant staphylococcus in the elderly patients with chronic bronchitis and to analyze its drug resistance .Methods The included cases adopted the French Biomerieux API bacterial automatic analysis software to conduct the throat swab culture and identification .Then in 362 isolated strains of staphylococcus ,the distribu‐tion rule and drug resistance of methicillin‐resistant staphylococcus strains were retrospectively analyzed .Results Among 362 iso‐lated strains of staphylococci ,171 strains were methicillin‐resistant staphylococcus ,the isolation rate was 47 .23% ,its resistance to levofloxacin ,oxacillin ,clindamycin ,azithromycin ,cefepime ,piperacillin/tazobactam had statistical difference compared with those of coagulase negative staphylococcus(P<0 .05) .Conclusion Methicillin‐resistant staphylococcus is an important pathogen in elderly patients with chronic bronchitis ,and has multi‐drug resistance to commonly used antibiotics ,therefore using antibiotics according to the drug susceptibility test results is the key to effective anti‐infection treatment .
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[Summary] A total of 128 individuals with type 2 diabetes underwent continuous glucose monitoring for 3 consecutive days.The dawn phenomenon was defined by three different parameters according to the previous research:(1)the absolute increase of glucose level from nocturnal nadir to prebreakfast value(?G) above 20 mg/dl;(2)?G above 10 mg/dl;( 3 ) insulin requirement increased at least 20%.The participants were secondarily separated by presence/absence of a dawn phenomenon based on the definitions above.The impact on blood glucose fluctuation of different groups was assessed according to the standard deviation of blood glucose( SDBG) , the area under curve above 10 mmol/L ( AUC ) , and the mean amplitude of glycemic excursions ( MAGE ) , etc.The frequencies of dawn phenomenon were 64.8%(?G≥20mg/dl), 85.2%(?G≥10 mg/dl), and 59.4%(rise in insulin requirement≥20%)respectively.The impacts on SDBG, AUC, MAGE, and MODD were without statistical difference(P>0.05) between the presence and absence of the dawn phenomenon patients when?G≥10 mg/dl.However, the differences reached statistical significance(P<0.05) when ?G≥20 mg/dl and the increase in insulin requirement≥20%. Besides, the incidence of dawn phenomenon was positively correlated with HOMA-IR, HbA1C , and free C-peptide.Dawn phenomenon is a very frequent event in type 2 diabetes and not only impacts the overall glycemic control but also exaggerates glucose fluctuation.To be clinically relevant, ?G≥20mg/dl should be taken as the quantitative criterion of the dawn phenomenon.
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[Summary] To investigate the association between sleep disorder and ambulatory blood pressure rhythm in patients with type 2 diabetes. 418 patients with type 2 diabetes were divided into two groups according to Pittsburgh sleep quality index ( PSQI):patients without sleep disorder and patients with sleep disorder. Oral glucose tolerance test, insulin releasing test, and C-peptide releasing test were performed to investigate the differences in the β-cell function, the circadian rhythm of blood pressure, and blood pressure variation between the two groups after fasting and glucose-load. The correlation and regression analysis were performed between PSQI and other indicators. (1)The level of HbA1C , fasting plasma insulin, area under curve of insulin, fasting plasma C-peptide, area under curve of C-peptide, and homeostasis model assessment for insulin resistance ( HOMA-IR) were significantly higher in patients withsleepdisordercomparedtothoseinpatientswithoutsleepdisorder[(8.2±2.1)% vs(7.4±1.8)%,(13.42± 4.55vs11.86±4.52)mU/L,(8.51±0.54vs8.38±0.51)mU·L-1·min,(2.42±1.25vs1.79±0.73)ng/ml, (6.59±0.39vs6.49±0.43)μg·L-1·min,4.63±1.12vs3.86±0.97,allP<0.05]. Insulinsensitivityindex (ISI) was lower in patients with sleep disorder than that in patients without sleep disorder(-4. 26 ± 0. 78 vs-4. 05 ± 0.62,P<0.05). (2)Thelevelof24hmeansystolicanddiastolicbloodpressure,nocturalsystolicanddiastolicblood pressure, and systolic blood pressure during daytime and nighttime were significantly higher in patients with type 2 diabetes who were suffering from sleep disorder. The blood pressure variation was more marked in patients with sleep disorder. (3)Multiple stepwise regression analysis showed that PSQI score was positively related to area under curve of C-peptide, HOMA-IR, 24 h mean systolic blood pressure, and noctural systolic blood pressure (β=0. 242, 0. 293, 0. 352, 0. 413, all P<0. 05), and negatively related to ISI and decreasing ratio of noctural systolic blood pressure (β=-0. 124 and -0. 226, both P<0. 05). Sleep disorder may cause abnormal circadian rhythm of blood pressure through various mechanisms. Improving sleep disorder may help to ameliorate insulin resistance and restore normal circadian rhythm of blood pressure.
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Through retrospective analysis of the clinical and laboratory data of 1 466 inpatients with type 2 diabetes mellitus(T2DM),we investigated the prevalence of chronic kidney disease (CKD) and analyzed the risk factors.The prevalence of CKD in hospitalized patients with T2DM was 52.25％.In the patients with CKD,protein urine was present in 93.47％ of the cases,27.93％ of them had glomerular filtration rate(eGFR) ≤60 ml · min-1 · 1.73 m-2,damage of renal tubular function was present in 24.28％,and abnormal renal imaging in 14.88％.Logistic regression showed that age,body mass index(BMI),duration of diabetes,systolic blood pressure,serum uric acid,low density lipoprotein-cholesterol (LDL-C),and smoking were independently associated with patients of T2 DM and CKD.The prevalence of CKD was increased with aging,diabetic course,BMI,and LDL-C.CKD is a common chronic complication in patients with T2DM,especially in patients with prolonged course,advanced age,and obesity.Much attention should be paid to early detection of CKD in patients with diabetes.In addition to detecting urinary protein and eGFR,renal tubular function and morphological examination should also be included.
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Objective To evaluate the functions of pancreatic islet α-cells and β-cells in different disease courses of type 2 diabetes mellitus.Methods Two hundred and eighty three patients with type 2 diabetes mellitus were divided into 4 groups according to their disease courses:group A (course of disease ≤1 years),group B (1 years ＜ course ≤ 5 years),group C (5 years ＜ course ≤ 10 years) and group D (course ＞ 10 years).Oral glucose tolerance test (OGTT),insulin releasing test and glucagon releasing test were performed to observe the differences of glucagon,glucagon/insulin,ratio of insulin increment/glucose increment 30 min after glucose-load (△I30/△G30),area under curve (AUC) of insulin in receiver operational characteristic (ROC) curve of insulin (AUCI) and glucagon among 4 groups and the correlation analysis was performed between glucagon and other indicators.Results (1) Glucagon,glucagon/insulin and AUC of glucagon increased significantly with the prolonged course of disease (P ＜0.05),0、30、60、120、180 min of group A were (71 ± 20)、(106 ± 36)、(143 ± 54)、(133 ± 68) 和 (87 ± 55) ng/L respectively,glucagon increased significantly with the prolonged course of disease,0、30、60、120、180 min of group D (80 ±19)、(125 ± 36)、(167 ± 47)、(178 ± 64)、(129 ± 65) ng/L respectively.(2) There were no significant differences in homeostasis nodel assessment for insulin resistance index (HOMA-IR) and insulin sensitive index (ISI) among 4 groups (P ＞0.05); compared to group A,HOMA of β-cell function (HOMA-β),△I30/△G30,AUCI in groups B,C and D were significantly lower (F =3.75,3.77 and 3.07 respectively,all P ＜ 0.05).(3) Multiple stepwise regression analysis showed that glucagon was positively correlated with FPG and AUC of glucose (AUCG) (t =6.23 and 3.41,all P ＜ 0.05),and negatively correlated with AUCI/AUCG (t =-2.13,P ＜ 0.05).Conclusions In order to reach the blood glucose control target,in the early stage of diabetes attentions should be given to regulation of glucagon while protect the β-cell function.
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Blood lipid level and its associations with insulin resistance were studied in patients with impaired glucose tolerance (IGT).Two hundred and twenty first degree relatives of type 2 diabetes mellitus were grouped into normal glucose tolerance (NGT) and IGT groups according to results of oral glucose tolerance test.Compared with the NGT group,the IGT patients had higher serum levels of total triglyceride (TG),total cholesterol (TC),low density lipoprotein-C (LDL-C) but a lower serum level of high density lipoprotein-C (HDL-C).Homeostasis model of assessment for insulin resistance index (HOMA-IR) and area under curve of insulin (AUCI) also increased.A positive relationship was found between TG and HOMA-IR (or AUCI),but a negative relationship existed between HDL-C and HOMA-IR.In conclusion,abnormal blood lipid metabolism is present in IGT patients and it has a close correlation with insulin resistance.
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The association of coagulation function with progressive proteinuria in type 2 diabetic patients was retrospectively analyzed.With increasing microalbuminuria,fibrinogen level was increased significantly.Fibrinogen was an independent risk factor of microalbuminuria. In patients as the early-stage diabetic nephropathy (DN)progressed to clinical-stage DN,the baseline level of fibrinogen was also increased [ ( 3.5 ± 0.9 vs 3.0 ± 0.6 ) g/L,P＜0.05 ].Fibrinogen may serve as a useful predictor of progressive proteinuria in type 2 diabetes.
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A cross-sectional study was performed among 5134 health check-up subjects in Tianjin Municipality.Compared with control group [ (274 ± 76)μmol/L],patients with non-alcoholic fatty liver disease (NAFLD) had a higher level of serum uric acid[ (340 ± 81 )μmol/L]. Moreover,in NAFLD patients,along with the increase of the severity of fatty liver from mild,intermediate to severe,the serum levels of uric acid increased from (331 ±78),(347 ± 83) to (377 ±75 ) μmol/L ( F =19.68,P ＜0.01 ).Regression analysis found that sex(β=-0.43 ),serum triglyceride(β =0.53 ),fasting plasma glucose(β =-0.21 )and BMI(β =0.19) were associated with uric acid level in NAFLD patients; but insulin level and homeostasis model of assessment-insulin resistance were not associated with uric acid level. The results indicate that serum uric acid levels may be used as a biomarker for the severity of NAFLD.
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In subclinical diabetic nephropathy with glomerular hyperfiltration,the renal size parameters are increased significantly,and this change sets in as early as before the appearance of microalbuminuria.The average kidney length discriminator value for glomerular hyperfiltration by receiver operating characteristic (ROC) curve analysis is 10.53 cm,with the best sensitivity,higher specificity and total coincidence rate,and can be a clinical indicator for screening early diabetic nephropathy with glomerular hyperfiltration.
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Objective To evaluate the inhibitory effect of statins on glucose-stimulated insulin secretion (GSIS) of pancreatic islet in rat and to explore its mechanisms. Methods According to the average volume, freshly isolated or 24-hour cultured pancreatic islets were randomly divided into control group( incubated with Kreb-Ringer bicarbonate buffer), the atorvastatin group( incubated with 100 μ mol/L atorvastatin), the fluvastatin group (incubated with 100 μ mol/L fluvastatin)and the pravastatin group (incubated with 100 μ mol/L pravastatin). Stimulated by 2. 8,5. 5,11.1,16. 7 mmol/L and 25.0 mmol/L glucose respectively, the effect of 100 μ mol/L statins on ATP content and GSIS was compared in the four groups. GSIS was performed by the 37℃ bath incubation method and ATP content was measured by chemiluminescence method. Results Incubated with 100 μ mol/L atorvastatin for 30 minutes, in the presence of 16. 7 mmol/L glucose, the ATP content [(9. 54 ± 1. 64) pmol/islet vs ( 12. 33 ± 1.89) pmol/islet] and GSIS (1.60 ± 0. 21 vs 2. 39 ± 0. 30) were significantly reduced in comparison with the control group (P＜0. 05). Cultured with 100 μmol/L fluvastatin for 24 hours, the ATP content [( 10. 24 ±2.01 )pmol/islet vs (12. 31 ±2. 16) pmol/islet] and GSIS (3. 12 ± 0. 32 vs 4. 17 ±0. 37 ) were all significantly decreased at the higher glucose concentration of 16. 7 mmol/L ( P ＜ 0. 05). Conclusion Atorvastatin and fluvastatin may inhibit GSIS by decreasing ATP content in pancreatic islet and the inhibitory effect is related to the strength of its lipophilicity.
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The mRNA expressions of chemerin and its receptor CMKLR1 in adipose tissue of OLETF rats and LETO rats were detected by real-time PCR. The results showed that the two genes mRNA expressions in subcutaneous and visceral adipose tissue in OLETF group were significantly higher than those in LETO group (P< 0.05 or P<0.01) and expressions of them in visceral adipose tissue were higher than those in subcutaneous adipose tissue(P<0. 05 or P<0. 01), suggesting that chemerin and CMKLR1 may be involved in the pathogenesis of obesity, insulin resistance, and type 2 diabetes mellitus.
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Objective To access evaluate the efficacy and safety of on-line hemodiafiltration for treating a-cute cerebrovascular disease (ACVD) patients complicated with hyperosmolar nonketotie diabetic coma (HNDC).Method Totally 11 patients of ACVD complicated with HNDC were observed for this prospective control study.All of them underwent on-line hemodiafiltrafion for 90 minutes using Fressnius 4008S Hemodialysis Machine withONLILNEplus TM and F60 one hour after final diagnosis was made. The bicarbonate ultrafiltrate rate was set at 500ml/min and blood flow at 150 ～ 180 ml/min; and the substitute fluid were infused with post-dilution at 50 ～ 60ml/min. The symptom of brain edema and cardiac insufficiency during the same course of treatment was observed.Blood were taken from the patients to detect serum kalium, serum glucose, serum natrium, BUN and plasma os-motic pressure at one hour before treatment and six hours after treatment, respectively. The change of in conscious-ness and adverse effects were evaluated at 24 hours after treatment. Results All patients were treated successful-ly. The blood glucose, serum natrium, serum kalium, BUN and plasma osmotic pressure were decreased after on-line hemodiafiltration. Among the 11 patients, consciousness was improved obviously in 8 patients, 3 patientsdied, accounting for 73% of successful effectiveness. Conclusions The on-line hemodiafiltration was effectiveand safe for treating ACVD patients complicated with HNDC.
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In order to explore the value of combined detection of atypical lymphocytes (ATL) and transaminase (alanine aminotransferase, ALT; asparate aminotransferase, AST) in the diagnosis of infectious mononucleosis (IM), The data of blood routine and liver function were collected from 54 IM patients, 34 acute hepatitis (AH) patients, 44 upper respiratory infection (URI) patients in Union Hospital during March 2002 to March 2005. Same data were also collected from 40 healthy children as normal control. These data were analyzed retrospectively. Both proportion of atypical lymphocytes and enzyme activity of transaminase were elevated simultaneously (ALT > 40 IU/L, AST > 45 IU/L) in 57.4% (31/54) IM patients. There was significant difference (P < 0.01) between IM group and the other groups. Combined detection of atypical lymphocytes and transaminase can be regarded as a diagnostic marker of infectious mononucleosis.
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In order to explore the value of combined detection of atypical lymphocytes (ATL) and transaminase (alanine aminotransferase, ALT; asparate aminotransferase, AST) in the diagnosis of infectious mononucleosis (IM), The data of blood routine and liver function were collected from 54 IM patients, 34 acute hepatitis (AH) patients, 44 upper respiratory infection (URI) patients in Union Hospital during March 2002 to March 2005. Same data were also collected from 40 healthy children as normal control. These data were analyzed retrospectively. Both proportion of atypical lymphocytes and enzyme activity of transaminase were elevated simultaneously (ALT＞40 IU/L,AST＞45 IU/L) in 57.4% (31/54) IM patients. There was significant difference (P＜0.01) between IM group and the other groups. Combined detection of atypical lymphocytes and transaminase can be regarded as a diagnostic marker of infectious mononucleosis.
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OBJECTIVE: To investigate the effects of resveratrol on the expression of SIRT1,the activity of eNOS and the secretion of NO of highlipid cultured primary human umbilical vein endothelial cells(HUVEC).METHODS: HUVEC were divided into normal control group,highlipid group and highlipid+resveratrol group,cultured for 24 hours.The expression of SIRT1 mRNA and protein were analyzed by RT-PCR and Western blot methods.Supernatant were used to analyze the nitric oxide(NO) content and activity of endothelial nitric oxide synthase(eNOS).RESULTS: Compared with highlipid group,resveratrol group increased the expression of SIRT1 mRNA and protein,the activity of eNOS and the secretion of NO(P
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<p><b>BACKGROUND</b>To study the relationship between the expression of E-cadherin and MVD in lung cancer and its significance.</p><p><b>METHODS</b>The expressions of E-cadherin and factor VIII were detected in 104 lung cancer tissues by immunohistochemical method, and MVD was calculated by image analysis system.</p><p><b>RESULTS</b>The expression of E-cadherin was significantly related to the differentiation of lung cancer (P < 0.05). A negative correlation was observed between E-cadherin expression and MVD in lung cancer tissues (P= 0.047).</p><p><b>CONCLUSIONS</b>Downexpression of E-cadherin and increase of MVD may play an important role in the invasion and metastasis of lung cancer, and may also be used as a useful marker for tumor prognosis.</p>