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Objective:To investigate the risk factors of low-level viremia (LLV) among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after combined anti-retroviral therapy (ART), and to provide evidence for reducing the risk of LLV.Methods:It was a cross-sectional observation study that enrolled HIV/AIDS patients with LLV (plasma HIV-1 RNA was 50 to 1 000 copies/mL) receiving ART over one year (LLV group) from January 2019 to December 2020 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University. Contemporaneous patients with ART over one year and successful viral suppression (plasma HIV-1 RNA<50 copies/mL) were randomly selected as the control group (suppression group) with a ratio of 1∶2.5, and the risk factors for LLV were analyzed by unconditional logistic regression.Results:A total of 128 and 297 patients were enrolled in LLV group and the suppression group, respectively.ART durations were 3.62(1.83, 4.89) years and 4.91(2.90, 5.88) years, respectively. Multivariate logistic regression analysis showed that the risk factors associated with LLV included the age of initial ART treatment above 50 years old (odds ratio ( OR)=1.82, 95% confidence interval ( CI) 1.01 to 3.26, P=0.046), the baseline HIV-1 RNA over 1×10 5 copies/mL ( OR=2.18, 95% CI 1.30 to 3.68, P=0.003), using the simplified initial ART regimen ( OR=1.82, 95% CI 1.02 to 3.26, P=0.044), missing medication more than three times per year ( OR=2.49, 95% CI 1.55 to 4.01, P<0.001) and changing regimen during ART ( OR=1.90, 95% CI 1.14 to 3.14, P=0.013), while the duration of ART longer than five years could reduce the risk of LLV ( OR=0.37, 95% CI 0.22 to 0.64, P<0.001). In patients with simplified initial ART regimen, the baseline CD4 + T lymphocyte count of whom with LLV was lower than that of whom with viral suppression, and the difference was statistically significant (94.00 (24.00, 281.00)/μL vs 375.00 (310.00, 435.00)/μL, Z=-2.60, P<0.001). Conclusions:The occurrence of LLV is related to the age of initial ART treatment, the baseline HIV-1 RNA, the initial ART regimen, the medication adherence and the change of ART regimen during ART. Strategies may be beneficial to reducing the risk of LLV for HIV/AIDS patients, such as initiating ART as soon as possible, using simplified regimen as initial regimen with caution in patients with low baseline CD4 + T lymphocyte counts, strengthening compliance education, avoiding unnecessary ART regimen changes.
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Objective:To compare the efficacy and safety of Changsulin ? with Lantus ? in treating patients with type 2 diabetes mellitus (T2DM). Methods:This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin ? or Lantus ? treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results:After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin ? and in Lantus ?, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin ? and Lantus ? in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin ? and Lantus ?, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin ? and Lantus ?, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions:Changsulin ? shows similar efficacy and safety profiles compared with Lantus ? and Changsulin ? treatment was well tolerated in patients with T2DM.
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Objective To investigate effect of exchange protein directly activated by cyclic adenosine monophosphate 1 on mechanical pain in diabetic rats.Methods Male SD rats were randomly divided into CON group and STZ group. CON group were further randomly divided into CONshRNA group,and CONEpac1shRNA group. STZ group induced diabetic mechanical pain (DMA) model were randomly divided into DMA shRNA group, DMA Epac1shRNA group,DMANS group,and DMA 8-pCPT group. The Epac1shRNA lentivirus vector is used to inhibit the expression of Epac1, and the shRNA lentivirus vector is negative control, and 8-pCPT is the activator of Epac1. Group CONshRNA and group DMAshRNA were given intrathecal injection of control shRNA lentivirus vector. Group CONEpac1shRNA and group DMAEpac1shRNA were injected with Epac1shRNA lentivirus carrier, DMANS group was injected into the plantar saline,and 8-pCPT in group DMA8-pCPT was injected into the foot. The changes of hind paw retraction threshold(PWT) were observed and the expression of guanine nucleotide transforming factor 1(Epac1) mRNA was detected by Real Time-PCR and Western blot in rat dorsal root ganglion(DRG) And protein expression changes.Results Compared with CON rats,the mechanical pain threshold of STZ rats decreased (P=0.035). Compared with saline group,the pain of injection Epac1 activator 8-pCPT group was prolonged(2h, P=0.012;4h,P=0.020). The expression of Epac1 mRNA and protein was significantly higher in the DMA group than in the CON group(both P<0.01). Intrathecal injection of shRNA reduced the expression of Epac1 mRNA and protein(P<0.01,P=0.020),and the PWT of the DMA group was significantly lower than that of the CON group (P=0.006).Conclusion Epac1 expression in diabetic rats with increased pain,and down-regulation of Epac1 may relieve pain.
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Objective To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM).Methods This was a 26-week,randomized,open-label,parallel-group,treat-to-target trial in 560 Chinese subjects with T2DM (men/women:274/263,mean age 56 years,mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs).Subjects were randomized 2:1 to once-daily IDeg (373 subjects) or IGlar(187 subjects),both in combination with metformin.The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks.Results Mean HbA1c decreased from 8.2％ in both groups to 6.9％ in IDeg and 7.0％ in IGlar,respectively.Estimated treatment difference (ETD) of IDegIGlar in change from baseline was-0.10％ points (95％ CI-0.25-0.05).The proportion of subjects achieving HbA1c ＜ 7.0％ was 56.3％ and 49.7％ with IDeg and IGlar,respectively [estimated odds ratio of IDeg/IGlar:1.26 (95 ％ CI 0.88-1.82)].Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar,respectively [estimated rateratio of IDeg/IGlar 0.69 (95％ CI 0.46-1.03),and 0.43 (95％ CI 0.19-0.97)].No differences in other safety parameters were found between the two groups.Conclusions IDeg was non-inferior to IGlar in terms of glycaemic control,and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia.IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment.Clinical trail registration Clinicaltrials.gov,NCT01849289.
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Objective To investigate the efficacy and safety of domestic exenatide injection versus imported exenatide injection in type 2 diabetic patients with inadequate glycemic control on monotherapy or combination therapy of metformin and insulin secretagogues. Methods A multicenter, randomized, parallel-controlled, and non-inferiority trial was carried out. A total of 240 subjects were randomized at a 1:1 ratio to add domestic exenatide injection (trial group) or imported exenatide injection (control group) on the background therapies. The primary endpoint of efficacy was HbA1C change from baseline to week 16. The secondary endpoints of efficacy were the proportion of HbA1C0.05). The changes in FPG, 2hPG, 7P-SMBG and body weight from baseline to week 16 were comparable between the two groups (all P>0.05). Moreover, the incidences of hypoglycemia and adverse events were similar between the two groups (both P>0.05). Conclusion In type 2 diabetic patients inadequately controlled by monotherapy or combination therapy of metformin and insulin secretagogues, the efficacy of cotreatment with domestic exenatide injection is not inferior to that of imported product ones, with a similar safety profile.
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Diabetic peripheral neuropathy is a common complication of diabetes mellitus,can occur in some patients with painful diabetic peripheral neuropathy.The occurrence of PDPN is related to many factors,such as long term severe hyperglycemia and metabolic disorders,deficiency of neurotrophic factors, disorder of microcirculation,increase of oxygen free radicals in oxidative stress and disorder of immune func-tion.Mitogen activated protein kinase (MAPK)is a kind of serine /tyrosine protein kinase ,which can widely expressed in cell,and can be involved in the pathophysiological process of stress,inflammation,cell cycle and apoptosis through increased nuclear transcription factors.P38MAPK signaling pathway is an im-portant branch of the MAPK,this overview focuses on the research progress of p38MAPK signaling pathway in the pathogenesis of PDPN.
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OBJECTIVE:To investigate the utilization of aspirin in patients with type 2 diabetes mellitus.METHODS:The utilization of aspirin in 510 inpatients with type 2 diabetes mellitus in the department of Endocrinology in our hospital from April 2004 to April 2007 was analyzed retrospectively.RESULTS:Of the total 510 cases,68.2% received aspirin,with daily dose reached 50～100mg.Aspirin was more often used in patients complicated with coronary heart disease and hypertension(P
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BACKGROUND: Metabolic disorder of blood lipid can be observed in the non-diabetic first-degree relatives.OBJECTIVE: To explore the relationship between the level of blood lipid and insulin resistance in members of type 2 diabetic pedigrees.DESIGN: A retrospective case control study of the non-diabetic first-degree relatives of type 2 diabetic families.SETTING: The department of endocrinology of a university hospital.PARTICIPANTS: This study was carried out in the Department of Endocrinology of the First Affiliated Hospital of Chongqing Medical College from June to November 1999. A total of 125 non-diabetic first-degree relatives of type 2 diabetic pedigrees in Chongqing were recruited and divided into hyperlipemia group and normal control group according to their blood lipid level.INTERVENTIONS: Body height, body mass and blood pressure of all the subjects were measured. Their cubital venous blood samples were also obtained for determination of the levels of fasting plasma glucose (FPG), fasting insulin(FINS), fasting C-peptide(FCP), triacylglycerol(TG), total cholesterol(TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C).homeostasis model assessment insulin resistance(HOMA-IR) between the two groups.RESULTS: The level of FINS was markedly higher in the hyperlipemia group [(12.92 ±5.26) μU/L] than in the control group[(9.15 ±4.66) μU/L]( t = 2. 17, P < 0.05) . HOMA-IR was also significantly higher in the hyperlipemia group [ (2.94 ± 1.25 ) ] than in the control group [ (2.01 ± 0.94) ]( t = 2.70, P < 0.01 ) . In the hyperlipemia group, HOMA-IR was positively correlated with TC, TG and LDL-C ( r = 0. 34, 0. 78, 0.42), with TG most closely correlated( r = 0. 78, P < 0. 01), while HOMA-IR had no significant relation with HDL-C ( P > 0.05).CONCLUSION: There is a close correlation between lipid metabolic disorder and insulin resistance in the high-risk diabetic group.
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Experimental results showed Zn(Ⅱ)-ammonium thiocyanate-hexadocyltrimethylammonium bromide complex was floated in the presence of sodium chloride. There fore Zn(Ⅱ) could be completely separated from Fe(Ⅲ), Co(Ⅱ),Ni(Ⅱ), Mn(ⅡD, Al(Ⅲ) by floation. The method is non-toxic, simple, rapid and economical.