Factors affecting cardiac autonomic neuropathy in diabetic patients with complications and construction of Nomogram prediction model / 中国医师进修杂志

Objective:To investigate the risk factors for concomitant cardiac autonomic neuropathy in diabetic patients and to develop a Nomogram prediction model.Methods:One hundred and fifty-eight diabetic patients admitted to in Southern Hospital Zengcheng Branch from March 2019 to March 2021 were selected. Patients with normal heart rate variability were the diabetic group, and patients with abnormal heart rate variability were the group with diabetes mellitus complicated by cardiac autonomic neuropathy. Logistic regression analysis was used to analyze the risk factors of cardiac autonomic neuropathy. Nomogram models were developed and model performance was evaluated. Decision curve analysis (DCA) was used to assess the net clinical benefit of the Nomogram model.Results:Comparison of general data showed that fasting blood glucose, tumour necrosis factor-α (TNF-α), glomerular filtration rate (eGER), uric acid, C-reactive protein (CRP), interleukin-6 (IL-6), free fatty acids (FFA), standard deviation of sinus heart beat RR interval (SDNN), and duration of diabetes compared to the diabetic group had statistically significant ( P<0.05); the results of the subject work characteristics (ROC) curve analysis showed that the best cut-off values for fasting glucose, TNF-α, eGFR, uric acid, CRP, IL-6, FFA, SDNN and duration of diabetes were >7.53 mmol/L, >98.45 ng/L, ≤94.79 ml/(min·1.73 m 2), > 87.3 μmol/L, >6.22 μmol/L, >37.84 ng/L, >839.19 μmol/L, ≤ 95.88 ms, >9 years; multi-factorial Logistic regression analysis showed that fasting glucose (>7.53 mmol/L), TNF-α (>98.45 ng/L), CRP (>6.22 μmol/L), IL-6 (>37.84 ng/L), FFA (>839.19 μmol/L), SDNN (≤95.88 ms), and duration of diabetes (>9 years) were risk factors for the development of cardiac autonomic neuropathy in diabetic patients; internal validation showed that the Nomogram model predicted a C-index of 0.706 (95% CI 0.668 - 0.751) for the risk of cardiac autonomic neuropathy. The DCA results showed that the Nomogram model predicted a risk threshold of >0.25 for the development of cardiac autonomic neuropathy and that the Nomogram model provided a net clinical benefit. Conclusions:There are many risk factors for cardiac autonomic neuropathy, and the nomogram model based on risk factors in this study has good predictive power and may provide a reference for clinical screening of high-risk patients and further improvement of treatment planning.

Changes in regional homogeneity of brain activity in patients with diabetic peripheral / 南方医科大学学报

OBJECTIVE@#To investigate the abnormalities in regional homogeneity of brain activity in patients with diabetic peripheral neuropathy (DPN) using resting-state functional magnetic resonance imaging (rs-fMRI) and explore the association between brain activity changes and DPN.@*METHODS@#A regional homogeneity (ReHo) approach was used to compare the local synchronization of rs-fMRI signals among 20 patients with painful DPN, 16 patients with painless DPN, and 16 type 2 diabetic patients without DPN (non-DPN group).@*RESULTS@#Compared with the those without DPN, the patients with painful DPN showed high ReHo in the left inferior temporal gyrus and the right central posterior gyrus, and low ReHo in the posterior cingulate gyrus, right inferior parietal gyrus, and the left superior parietal gyrus ( < 0.05);the patients with painless DPN group showed high ReHo in the left inferior temporal gyrus, the right middle temporal gyrus, and the right superior frontal gyrus, and low ReHo in the left thalamus ( < 0.05).No significant differences in ReHo were found between the patients with painful DPN and painless DPN (>0.05).@*CONCLUSIONS@#The patients with DPN have altered ReHo in multiple brain regions and impairment of a default mode network, for which the left temporal gyrus may serve as a functional compensatory brain area. ReHo disturbance in the central right posterior gyrus may play a central role in the pain symptoms associated with painful DPN.

Distribution of pathogens in diabetic foot osteomyelitis and risk factors of osteomyelitis / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis.</p><p><b>METHODS</b>A total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis.</p><p><b>RESULTS</b>Gram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05).</p><p><b>CONCLUSION</b>In addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.</p>

1,25-dihydroxyvitamin D3 pretreatment inhibits house dust mite-induced thymic stromal lymphopoietin release by human airway epithelial cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of 1,25-dihydroxyvitamin D3 (1,25VD3) on house dust mites (HDM)-induced expression of thymic stromal lymphopoietin (TSLP) in human airway epithelial cells in vitro.</p><p><b>METHODS</b>Human airway epithelial 16HBE cells were incubated with 200, 400, and 800 U/L in the absence or presence of 1,25VD3 (10(-8) mol/L) for 6 h and 24 h, and TSLP mRNA and protein expressions in the cells were assessed using quantitative PCR and ELISA.</p><p><b>RESULTS</b>16HBE cells incubated with HDM at 200, 400, and 800 U/L showed significantly increased TSLP mRNA and protein expressions (P<0.05). Pretreatment of the cells with 1,25VD3 obviously lowered 400 U/L HDM-induced TSLP expressions (P<0.05), but 1,25VD3 added along with HDM in the cells did not produce significant effects on TSLP expressions (P=0.58).</p><p><b>CONCLUSION</b>Both 1,25VD3 and HDM can induce TSLP expression and release in 16HBE cells, but pretreatment with 1,25VD3 can decrease HDM-augmented TSLP expression in the cells.</p>

Protective effect of protein kinase C inhibitor Ro-31-8425 on hyperpermeability of human umbilical vein endothelial cells exposed to high glucose in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of different concentrations of glucose on the permeability of human umbilical vein endothelial cell monolayer and the protective effect of protein kinase C (PKC) inhibitor Ro-31-8425 against high-glucose exposure.</p><p><b>METHODS</b>Cultured human umbilical vein endothelial cell line EA.hy926 cells were exposed to 5.5 mmol/L glucose (control) and high-concentration glucose (10, 15, 20, 25.5, and 30 mmol/L), and the endothelial monolayer permeability was assessed by measuring the flux of FITC-labeled dextran (FITC-DΧ) across the endothelial cells. The cultured EA.hy926 cells were treated with 5.5 mmol/L glucose +saline, high glucose (25.5 mmol/L) +saline, or high glucose (25.5 mmol/L) +Ro-31-8425(10 µmol/L), and the level of PKC phosphorylation and endothelial monolayer permeability were evaluated.</p><p><b>RESULTS</b>High glucose dose-dependently increased the permeability of the endothelial cell monolayer (P<0.01), and glucose at 25.5 mmol/L significantly increased the phosphorylation level of PKCα and PKCβ II in the cells (P<0.01). Treatment with 10 µmol/L Ro-31-8425 obviously attenuated high-glucose-induced PKCα and PKCβ II phosphorylation (P<0.01) as well as the increase of the cell monolayer permeability (P<0.01).</p><p><b>CONCLUSIONS</b>High glucose increases the hyperpermeability of human umbilical vein endothelial cell monolayer mediated by the phosphorylation of PKC, and the PKC inhibitor Ro-31-8425 can reverse such effects.</p>