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Hypoglycemia is the most common complication of the treatment for diabetes mellitus. Current studies suggest that recurrent hypoglycemia induces impaired awareness of hypoglycemia in diabetes by the failure of sympathetic nerve response or other mechanisms, which increases the risk of severe hypoglycemia and hypoglycemic fear in diabetics. Therefore, exploring the pathogenesis and preventive measures of impaired awareness of hypoglycemia is expected to provide new ideas for reducing severe hypoglycemia events and conducting subsequent studies.
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The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.
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Diabetic cardiomyopathy is a myocardial complication associated with abnormal glucose metabolism and dyslipidiaemia, which increases the risk of death and heart failure in diabetic patients. Mitochondrial dysfunction is involved in the occurrence and development of diabetic cardiomyopathy. Recent studies have confirmed that scavenging damaged mitochondria in cardiomyocytes through mitophagy can restore mitochondrial homeostasis, reduce oxidative stress and improve diabetic cardiomyopathy. Therefore, this article provides a comprehensive review of the mechanisms and characteristics of mitochondrial autophagy in diabetic cardiomyopathy. It aims to offer new insights and theoretical basis for the prevention and treatment of diabetic cardiomyopathy.
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With the aging of the global population and changes of the lifestyle, the number of patients with comorbid sarcopenic obesity and diabetes mellitus is increasing. The pathogenesis of the two diseases is closely related, and the coexistence of them may lead to more adverse outcomes. This article reviews the diagnostic criteria and epidemiology of sarcopenic obesity, evidence on its relationship with diabetes, and the management of comorbidities, aiming to provide insights for clinical practice.
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Objective:To evaluate the influencing factors of inconsistency between γ-interferon release test QFT-GIT and etiological results in tuberculosis patients.Methods:The clinical data of 1 398 patients with positive Mycobacterium tuberculosis infection confirmed by pathogen culture after QFT-GIT test who were admitted to Hangzhou Chest Hospital Affiliated to Zhejiang University School of Medicine from September 2017 to August 2021 were retrospectively analyzed. There were 1 242 cases in whom both the pathogenic culture and QFT-GIT results were positive(consistent result group) and 156 cases in whom the QFT-GIT test results were negative or indeterminate(inconsistent result group). Logistic regression was used to analyze the influencing factors of inconsistent results between QFT-GIT and tuberculosis pathogenic tests. SPSS 25.0 software was used to analyze the data. Results:The overall incidence of inconsistency between QFT-GIT and tuberculosis etiological results was 11.16% (156/1 398). The incidence of inconsistency was 0, 7.09% (63/889) and 19.58% (93/475) in patients aged <18, 18-<65 and ≥65 years old, respectively; the incidence of inconsistency in age group ≥65 was higher than that in age groups <18 and 18-<65 ( χ2=6.584 and 36.762, P<0.01). Multivariate Logistic regression analysis showed that age ( OR=1.026, 95% CI 1.016-1.037), smoking ( OR=1.649, 95% CI 1.159-2.347), chronic liver disease ( OR=1.868, 95% CI 1.213-2.876), cardiovascular disease ( OR=2.353, 95% CI 1.361-4.069) and blood albumin level ( OR=0.956, 95% CI 0.928-0.985) were independent influencing factors for the inconsistency between the results of QFT-GIT and tuberculosis etiology. Conclusion:Patients with advanced age, smoking, chronic liver disease, cardiovascular disease and low albumin level are more likely to have inconsistent results between QFT-GIT and tuberculosis etiological tests.
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Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Hypoglycemia is very common in daily blood glucose management of diabetic patients, and growing number of studies have proved that hypoglycemia plays an important role in the pathogenesis of cognitive dysfunction. There may be a bidirectional relationship between severe hypoglycemia and cognitive dysfunction, resulting in a vicious circle of mutual aggravation between hypoglycemia and cognitive dysfunction, but the specific mechanism is not clear. This article reviews the relationship between hypoglycemia and cognitive dysfunction, the mechanism of hypoglycemia induced cognitive dysfunction, and clinical management measures. The aim is to improve the understanding of the relationship between hypoglycemia and cognitive dysfunction, and to provide scientific basis for further exploring the mechanism of diabetes mellitus with cognitive dysfunction.
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Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Objective:To evaluate the diagnostic effects of Xpert MTB/RIF, Fluorescence PCR melting curve and gene chip technology for rapid screening of rifampicin-resistant tuberculosis.Methods:The clinical data of 150 patients diagnosed with tuberculosis by Bactec MGIT 960 liquid culture drug susceptibility in Zhejiang Chinese Medicine and Western Medicine Integrated Hospital from September 2016 to August 2019 were collected, including Xpert MTB/RIF and gene chip results. The isolated and cultured strains from patients were subjected to fluorescence PCR melting curve detection. Using Bactec MGIT 960 drug susceptibility results as the reference, the diagnostic efficacy of Xpert MTB/RIF, Fluorescence PCR melting curve and gene chip technology for rifampicin resistance were analyzed, and the receiver operating characteristic curve (ROC) was drawn for comparative analysis.Results:Take Bactec MGIT 960 as the gold standard, the sensitivity of Xpert MTB/RIF, Fluorescence PCR melting curve and gene chip technology for rifampicin resistance were 88.89% (16/18), 94.44% (17/18), 88.89% (16/18) respectively; the specificity were 96.21% (127/132), 96.21% (127/132), 95.45% (126/132), respectively. There was no statistically significant difference in the sensitivity and specificity among the three detection methods ( P>0.05). The Kappa values of the three molecular methods for detecting rifampicin resistance were 0.794, 0.827 and 0.770, respectively. The three detection methods have good diagnostic value for rifampicin resistance ( P<0.01), but there is no statistically significant difference between the three methods ( P>0.05). There were 8 cases of inconsistent results between the three methods and Bactec MGIT 960 drug sensitivity. Conclusion:Xpert MTB/RIF, Fluorescence PCR melting curve and gene chip technology have comparable ability to detect rifampicin resistance, all of these have high sensitivity and specificity for detecting rifampicin resistance and are suitable for rapid screening.
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Objective To construct a"Field and Disaster Nursing"course which is suitable for the military and local higher nursing education, on-the-job and post training education to organic integrate the modern disaster nursing teaching and military field nursing teaching. Methods Based on the methods of qualitative and quantitative research, such as literature research, interviews and observational method, a preliminary plan of curriculum design was established, and an expert consultation table was designed.The Delphi expert consultation method was used to conduct two rounds of consultation with 30 related experts on disaster relief.Quantitative data were obtained and statistical data were analyzed. Results The final screening results of the curriculum content applicability index are 4 first grade, and 23 for the two level.A set of"Field and Disaster Nursing"curriculum had been set up that is suitable for education and training needs of the military and local fusion. Conclusion The construction of this course provides a training thought for exploring disaster nursing education suitable for China's national conditions, and has reference and guiding significance for further implementation of military and civilian integration and multi participatory disaster nursing teaching practice.
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Objective To compare the application of PCR-fluorescence probe, Bactec MGIT960 and Xpert MTB／RIF in diagnosis of tuberculosis from non-respiratory specimens.Methods Non-respiratory specimens from 225 patients with suspected tuberculosis admitted in Zhejiang Hospital of Integrated Chinese Medicine and Western Medicine from October 2017 to August 2018 were collected.There were 177 cases of tuberculosis and 48 cases of non-tuberculosis confirmed by clinical diagnosis.All specimens were tested with PCR-fluorescence probe, Xpert MTB／RIF and Bactec MGIT960.The clinical diagnostic results were used as the gold standard, and the receiver operating characteristic curve ( ROC) was drawn to evaluate the diagnostic values of three methods.The consistency of PCR-fluorescence probe method with Xpert MTB／RIF assay was analyzed.Results The sensitivity of PCR-fluorescent probe, Xpert MTB／RIF and Bactec MGIT960 in diagnosis of tuberculosis was 53.67%(95／177), 58.76%(104／177) and 31.07%(55／177), respectively.The sensitivity of PCR-fluorescent probe and Xpert MTB／RIF was higher than that of Bactec MGIT 960 culture ( χ2 ＝17.60 and 27.41, P＜0.01), while there was no significant difference between the PCR-fluorescent probe and the Xpert MTB／RIF (χ2 ＝0.93, P＞0.05).The specificity of three methods were 100.00%(48／48), 100.00%(48／48) and 97.92%(47／48), respectively (F＝1.83, P＞0.05).ROC curve analysis showed that the area under the ROC curve ( AUC) of PCR-fluorescent probe, Xpert MTB／RIF, and Bactec MGIT960 was 0.768, 0.794, and 0.645, respectively.The diagnostic value of PCR-fluorescent probe and Xpert MTB／RIF for tuberculosis was significantly higher than that of Bactec MGIT960 (Z＝5.19 and 6.52, P＜0.01); while Xpert MTB／RIF was superior to PCR-fluorescence probe (Z＝2.8, P＜0.05).In various types of specimens , there was no significant difference in the detection rate of tuberculosis between PCR-fluorescent probe method and Xpert MTB／RIF (χ2 ＝0.73, P＞0.05).The PCR-fluorescent probe and Xpert MTB／RIF had a good consistency (kappa＝0.829).Conclusion Xpert MTB／RIF is superior to PCR-fluorescence probe in the detection of tuberculosis in non-respiratory specimens such as tissues and pus, but the two have good consistency.The PCR-fluorescence probe method is economical and practical , and easy to promote, which has a high clinical application prospects.
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AIM: To explore the effects of exendin-4 (EX-4) on endoplasmic reticulum stress (ERS)-mediated insulin resistance in the 3T3-L1 adipocytes.METHODS: In vitro 3T3-L1 pre-adipocytes were differentiated into adipocytes, and the cells were treated with tunicamycin (TM), tauroursodeoxycholic acid (TUDCA) or EX-4, respectively.The cell viability was measured by MTT assay.The glucose consumption was determined by glucose oxidase assay to evaluate insulin sensitivity of the 3T3-L1 adipocytes with different interventions.The protein levels of p-Akt, Akt and endoplasmic reticulum stress markers, including inositol requiring enzyme-1 (IRE1), p-IRE1, JNK, p-JNK, protein kinase R-like endoplasmic reticulum kinase (PERK), p-PERK, eukaryotic initation factor 2 alpha (eIF2a), p-eIF2a, activating transcription factor-6(ATF-6) were detected by Western blot.RESULTS: The insulin-stimulated glucose consumption and the protein level of p-Akt were inhibited by TM at 5 mg/L for 5 h (P<0.05), while they were increased when the cells were treated with TUDCA at 1 mmol/L or EX-4 at 100 nmol/L for 24 h (P<0.05).The effects above induced by TM (5 mg/L for 5 h) were also blunted by pretreating with TUDCA at 1 mmol/L or EX-4 at 100 nmol/L for 24 h (P<0.05).The protein levels of ERS markers such as p-IRE1, p-JNK, p-PERK, p-eIF2a and ATF-6 were significantly increased by treating with TM at 5 mg/L for 5 h, whereas 24 h pre-treatment with TUDCA or Ex-4 alleviated the ERS of the 3T3-L1 adipocytes induced by TM.The expression of total IRE1, JNK, PERK and eIF2a was not changed in different groups.CONCLUSION: Exendin-4 improves endoplasmic reticulum stress mediated insulin resistance in 3T3-L1 adipocytes.
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Objective To investigate the efficacy and safety of long guidewire exchange technique in performing cerebral angiography via radial artery approach.Methods The clinical data of 257 patients,who received cerebral angiography during the period from June 2014 to May 2016 at Daxing Hospital of Capital Medical University,Beijing,China,were retrospectively analyzed.Among the 257 patients,186 had type Ⅱ or type Ⅲ aortic arch.According to the different looping technologies for Simmons-2 catheter used in the performance of cerebral angiography,these 186 patients were divided into the study group (n=90) and the routine group (n=96).The success rate of radial artery puncturing,the success rate of Simmons-2 catheter looping formation,the success rate of supra-arch arterial catheterization,the time spent for angiography,the radiation exposure time,complications,etc.were recorded.Results The success rate of radial artery puncturing was 100％ in both groups.The success rate of Simmons-2 catheter looping formation in the study group was 97.8％,which was significantly higher than 72.9％ in the routine group (P＜0.05).The success rates of catheterization for the left subclavian artery,left common carotid artery and right carotid artery in the study group were 97.8％,97.8％ and 97.8％ respectively,which were remarkably higher than 72.9％,72.9％ and 72.9％ respectively in the routine group (P＜0.05).No statistically significant difference in the success rates of catheterization for right subclavian artery and for right vertebral artery existed between the two groups (P＞ 0.05).The time spent for angiography in the study group and the routine group was (22.5±9.4) min and (28.3±8.3) min respectively.The radiation exposure time in the study group was (8.9±4.5) min,which was obviously lower than (12.6±6.5) min in the routine group (P=0.017 and P=0.035,respectively).The incidences of complications in the study group and the routine group were 4.4％ and 5.2％ respectively,the difference was not statistically significant (P＞0.05).No severe complications,such as intracranial arterial embolie events,puncture bleeding,arterial occlusion,etc.,occurred in all patients of both groups.Conclusion The use of long guidewire exchange technology can improve the success rate of Simmon-2 catheter looping formation and the success rate of supra-arch arterial catheterization,it can also shorten the time for angiography procedure and reduce the radiation exposure time.This technique is very effective with higher safety.Therefore,this long guidewire exchange technique should be used as a common method for cerebral angiopraphy via radial artery approach in patients with type Ⅱ or type Ⅲ aortic arch.
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Aim To study influence of PTEN inhibitors ( PIC) on high glucose induced endothelial cell senes-cence Methods ( 1 ) HUVECs were cultured in ECM medium. Cell viability was determined by CCK-8. Cells were randomly divided into control group ( C ) , high glucose group ( HG ) , high glucose +10 nmol · L-1 PIC group ( HG +10 nmol · L-1 PIC ) , high glu-cose+100 nmol · L-1 PIC group ( HG +100 nmol · L-1 PIC) . Cell apoptosis was examined by flow cytom-etry. Senescence Detection Kit was performed by SA-β-gal Cytochemical staining. The expression levels of genes and protein ( p16 and Pten ) were detected by real-time PCR and Western blot. Results The prolif-eration rate was markedly decreased in HG group com-pared with C group, and this phenomenon was reversed by PTEN inhibitors . Cell apoptosis was significantly increased in HG group compared with C group, and a-gain these changes were blocked by PIC. The expres-sion levels of genes ( PTEN) were significantly higher in HG group compared with C group. The frequency of senescent ( SA-β-Gal-positive ) cells and the expres-sion level of senescence genes ( p16 ) were significantly higher in HG group compared with C group, and these changes were blocked by PIC. Conclusion These re-sults show that PTEN inhibitors ( PIC ) delays cellular senescence that is promoted under high glucose condi-tion.
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Objective To study the set-up errors by CBCT in IMRT with two different immobilization techniques for thoracic and abdominal tumors.Methods Sixty patients with thoracic and abdominal tumor were included in this study and separated into study group and the control group.The study group were immobilized with carbon fiber holder,vacuum bag and thermoplastic mask.The control group were immobilized with carbon fiber holder and thermoplastic mask.CBCT scan and auto-match online were regularly performed before the treatment.The setup of left-right(x),superior-inferior(y),anterior-posterior (z) were received.The value of the Mptv was calculated,meanwhile.The grouped t-test of was carried out between these two methods.Results The shift errors in x-,y-,z-dimension of the study group were (0.32 ± 2.58) mm,(-0.40 ± 3.89) mm,(-0.75 ± 2.43) mm.The Mrrv were 5.60 mm,6.08 mm,6.32 mm.The translation set-up errors in x-,y-,z-dimension of the control group were(0.62 ±3.60),(2.44 ± 4.93),(0.66 ±2.85) mm,respectively.The MPrv were 8.07,10.63,6.90 mm,respectively.The t-test value were t =-0.78,-5.11,-4.22,P =0.440,0.000,0.000,respectively.Conclusions The immobilization techniques with carbon fiber holder,vacuum bag and thermoplastic mask would be better than the techniques without the vacuum bag in reducing the setup errors.
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Objective: To retrospectively characterize and analyze the thyroid ultrasound images of thyroid cancer patients, to classify thyroid nodules according to thyroid imaging reporting and data system (TI-RADS), and to evaluate the diagnostic value of TI-RADS. Methods:Clinical data of 160 thyroid cancer patients with 235 nodules from September 2008 to August 2011 were retro-spectively analyzed. All patients underwent conventional color Doppler ultrasonography to evaluate the size, number, shape, boundary, and extent of lesions and blood distribution of the nodules. All nodules were analyzed according to TI-RADS classification and scored to evaluate the diagnostic value of TI-RADS. Results:Among 176 malignant nodules, 144 (81.8%) had lesions showing a mass of irreg-ular boundary with no envelope and halo, 152 (86.4%) were inhomogeneous hypoechoic or slightly hypoechoic, or 144 (81.8%) exhibit-ed microcalcification. TI-RADS scores of 4 or 5 and 2 or 3 were obtained in 160 (90.91%) and 16 (9.09%) of the malignant nodules, re-spectively. Conclusion:Thyroid ultrasound sonogram of ill-defined, irregular shape, hypoechoic or slightly hypoechoic mass, microcal-cification within the mass, and rich blood flow is an important index for the diagnosis of thyroid cancer. Thyroid nodules with a TI-RADS score 4 or 5 have higher possibility for cancer. Therefore, TI-RADS has a significant diagnostic value for thyroid cancer be-fore operation.
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Fasting blood ghrelin level was decreased,and postprandial ghrelin descent was suppressed in high-fat diet induced obese rats.Fasting ghrelin concentration,but not postprandial ghrelin concentration,was negatively correlated with body weight,insulin resistance index,and glucose level.
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Cone-beam CT (CBCT) of Elekta can be used to analyze the setup errors in intensity modulated radiotherapy. A total of 240 patients with head and neck cancer were chosen in the period from October, 2009 to October, 2010. Their CBCT images were obtained after initial setup, and registered to the planning CT images, and then the setup errors on translational directions (X, Y, Z) and on rotational directions (U, V, W) were obtained and analyzed. The results showed that the setup errors on translational directions in Y-axis and Z-axis were larger than in X-axis, and the setup errors on rotational directions in Y-axis was much more obvious than those on the other two directions, which should be taken care during the patient daily setup. It may be concluded that the CBCT system can improve the precision for radiotherapy.
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Humans , Cone-Beam Computed Tomography , Methods , Head and Neck Neoplasms , Diagnostic Imaging , Radiotherapy , Radiotherapy Setup Errors , Radiotherapy, Intensity-ModulatedABSTRACT
The changes of serum malondialdehyde, myeloperoxidase, total antioxidant capacity, superoxide dismutase activity, and glutathione peroxidase were observed in patients with Graves′ disease. The myeloperoxidase level increased in patients with Graves′ disease. The balance between oxidation and antioxidative defense was disrupted in patients with newly-onset Graves′ disease. Oxidative stress seems to be related to hyperthyroidism.
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As one of the most sensitive cells of endoplasmic reticulum stress,pancreatic βcells have an abundance of endoplasmic reticulum .It is the adaptive response of pancreatic β cells under Endoplasmic reticulum stress conditions.Internal and external factors in the environment such as oxidative damage,lipid toxicity and the effect of cytokines in the endoplasmic reticulum could breake the steady-state,resulting in barriers to folding or misfolding of protein,thereby to trigger endoplasmic reticulum stress.Serious and lasting stress will lead to β cell apoptosis,involved in a variety of metabohc diseases as well as a variety of diseases.This article gives a review on the injury effects of multi-factor induced endoplasmic reticulum stress on the pancreatic β-cell