Perfil clínico-metabólico de pacientes pé diabéticos frequentadores de uma Unidade Básica de Saúde de Altamira, Pará, Brasil / Clinical-metabolic profile of diabetic foot patients attendinga Basic Health Unit in Altamira, Pará, Brazil

Introdução: o pé diabético é de origem neuropática e representa uma das complicações do diabetes mellitus, abrange várias condições patológicas, que incluem neuropatia, doença arterial periférica, neuroartropatia de Charcot, ulceração do pé e, em alguns casos, amputação. Objetivo: descrever o perfil clínico-metabólico de pacientes pé diabéticos frequentadores de uma Unidade Básica de Saúde (UBS). Material e Método: trata-se de um estudo descritivo exploratório com abordagem quantitativa. Foram avaliados 15 pacientes portadores de úlceras do pé diabético atendidos em uma Unidade Básica de Saúde de Altamira, estado do Pará, Brasil. Os dados foram submetidos à análise de acordo com os indicadores dos perfis investigados. Resultados: todos os pacientes possuem diabetes tipo II, baixos níveis de renda familiar e escolaridade. O Índice de Massa Corpórea (IMC) foi de 92%, circunferência abdominal 93%, proteína C reativa ultrassensível, interleucina-6 e hemoglobina glicada estavam superiores ao normal em mais da metade dos doentes, assim como a vitamina D estava deficiente em mais da metade dos pacientes. Conclusões: há barreiras ao manejo adequado dos portadores de pé diabético na atenção básica da cidade de Altamira que podem contribuir para o desenvolvimento de complicações macro e microvasculares. Recomendações técnicas direcionadas aos gestores locais contribuem para a atenção básica na região.

Introduction: the diabetic foot is of neuropathic origin and represents one of the complications of diabetes mellitus, encompasses several pathological conditions, including neuropathy, peripheral arterial disease, Charcot neuroarthropathy, foot ulceration, osteomyelitis and, in some cases, amputation. Objective: to describe the clinical-metabolic profile of diabetic foot patients attending a Basic Health Unit (BHU). Material and Method: this is a descriptive exploratory study with a quantitative approach. Fifteen patients with diabetic foot ulcers treated at the Basic Health Unit in Altamira, state of Pará, Brazil, were evaluated. The data were submitted to analysis according to the indicators of the investigated profiles. Results: all patients have Type 2 Diabetes, low level of family income and education. The Body Mass Index (BMI) was 92%, abdominal circumference (93%), Ultrasensitive C-Reactive Protein, Interleukin-6 and glycated hemoglobin were higher than normal in more than half of the patients, as well as vitamin D was deficient in more of half of the patients. Conclusions: there are barriers to the proper management of patients with diabetic foot in primary care in the city of Altamira that can contribute to the development of macro and microvascular complications. Technical recommendations directed at local managers contribute to primary care in the region.

Diagnosis and treatment of diabetic retinopathy under the guidance of traditional Chinese and western medicine theory / 中国基层医药

Diabetic retinopathy is one of the serious microvascular diseases caused by diabetes. It is the leading cause of visual impairment among workers over 40 years old in developed countries. At present, western medicine methods for treating diabetic retinopathy include pan-retinal photocoagulation, vitrectomy, and intravitreal injection of anti-vascular endothelial growth factor and other methods. Traditional Chinese medicine treatment of diabetic retinopathy is mainly to treat patients using oral Chinese herb preparation based on syndrome differentiation and using certain external traditional Chinese medicine methods, such as auricular point therapy. This paper investigates the research progress of diabetic retinopathy treatment with traditional Chinese and western medicine and provides novel ideas for treating diabetic retinopathy with traditional Chinese combined with western medicine.

Correlations between macular microvascular parameters in patients with type 2 diabetes mellitus and urinary albumin creatinine ratio / 中华眼底病杂志

Objective:To observe and analyze the correlation between macular microvascular parameters and urinary albumin to creatinine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study. From October 2017 to April 2018, 100 eyes of 100 patients (T2DM) and 27 eyes of 27 healthy controls (the control group) were enrolled in Xuzhou First People’s Hospital. All subjects underwent anterior segment examination via slit-lamp biomicroscopy, dilated fundus examination, 7-field fundus photographs, OCT angiography (OCTA), the fasting glucose test, glycosylated hemoglobin (HbA1c), urinary albumin, urinary creatinine and UACR levels determination. Height and weight measurement were taken for calculating body mass index (BMI). Diabetic retinopathy was ruled out by fundoscopic examinations and 7-field fundus photographs in T2DM patients. According to the UACR, patients in the T2DM group were subdivided into A1 group (UACR< 30 mg/g), A2 group (UACR 30-300 mg/g), and A3 group (UACR>300 mg/g), with 38 cases and 38 eyes respectively , 40 cases with 40 eyes, 22 cases with 22 eyes. A 6 mm×6 mm scanning area centered on the macular fovea were scanned for right eye using a frequency domain OCTA instrument, which were divided into three concentric circles centered on the macular fovea by the software automatically. The foveal zone was defined as a circular area measuring 1 mm in diameter, the parafoveal zone was described as a middle circle area measuring 1-3 mm in diameter, and the perifoveal zone was an outer circle area measuring 3-6 mm in diameter. The vessel density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular area (FAZ) and perimeter (PERIM), non-circularity index (AI) were measured. The correlation between the macular vessel density, FAZ and UACR was analyzed by Spearman correlation analysis.Results:A1 group, A2 group, A3 group, and normal control group. The macular area SCP and DCP ( F=13.722, 5.644), foveal area ( F=4.607, 4.719), parafoveal area ( H=23.142, F=2.904), the blood flow density of the area around the fovea ( F=12.292, H=10.946), the difference was statistically significant ( P<0.05); with the increase of UACR, the blood flow density of each area of SCP and DCP showed a downward trend. The results of correlation analysis showed that the blood flow density of the whole SCP, parafoveal area, and surrounding area of T2DM patients was negatively correlated with UACR ( r=-0.376, -0.240, -0.364,-0.347, P<0.05). There were no correlation among fasting plasma glucose, HbAlc and UACR ( r=0.179, 0.085, P>0.05). There were no correlation among blood flow density in BMI, SCP foveal area, DCP and UACR (| r|<0.3, P>0.05). Conclusion:The whole, parafovea and perifovea vessel density values of SCP in T2DM eyes without DR are negatively correlated with UACR.

Study on retinal neurodegeneration and microvascular lesions in diabetic patients / 中华眼底病杂志

Objective:To observe the changes in the structure and function of the retina in diabetic patients, and preliminarily explore the changes in the characteristics of neuropathy and microvascular damage in different degrees of diabetic retinopathy (DR).Methods:A prospective controlled study. From May to December 2020, 63 eyes of 63 patients with type 2 diabetes who were recruited from the Department of Ophthalmology of Shandong Provincial Hospital and 40 healthy volunteers with age and sex matching in the same period (control group) were included in the study. All subjects underwent optical coherence tomography angiography (OCTA) and portable non-mydriatic visual electrophysiological diagnosis system RETeval. OCTA was used to measure the thickness of the retinal nerve fiber layer (pRNFL) around the optic disc, the blood flow density of theradial peripapillary capillary (RPC) around the optic disc, and the thickness of the macular ganglion cell complex (GCC). The "DR evaluation plan" mode of the RETeval device was used to perform flash electroretinogram examination, and the "DR evaluation score" measured by the system was recorded. According to the DR grading standard established in the early treatment of DR research, DR was classified. Diabetic patients were divided into non-DR (non-DR) group, mild to moderate non-proliferative DR (mNPDR) group, and severe non-proliferative DR (sNPDR) group, Proliferative DR (PDR) group, with 12, 16, 18, and 17 eyes respectively. The comparison of pRNFL thickness, GCC thickness, RPC blood flow density and "DR assessment score" between groups was performed by one-way analysis of variance; the correlation between pRNFL thickness and RPC blood flow density was analyzed by Pearson correlation analysis.Results:Compared with the control group, the overall, upper and lower thickness of the macular GCC of the affected eyes in different degrees of DR groups were significantly thinner, and the difference was statistically significant ( F=13.560, 15.840, 5.480; P<0.05). Compared with the control group, the overall pRNFL ( F=6.120), upper part ( F=6.310), lower part ( F=5.330), upper nose ( F=7.350), lower nose ( F=2.690), the upper nasal side ( F=4.780), the upper temporal side ( F=3.710), and the lower temporal side ( F=3.750) became thinner, the difference was statistically significant ( P<0.05). Correlation analysis results showed that the whole optic disc, upper part, lower part, upper nose, upper nasal side, lower nasal side, and lower temporal RPC blood flow density were positively correlated with pRNFL thickness ( r=0.260, 0.256, 0.275, 0.489, 0.444, 0.542, 0.261; P<0.01). The "DR evaluation scores" of the eyes in the control group, non-DR group, mNPDR group, sNPDR group, and PDR group were 12.71±5.62, 22.18±3.77, 24.68±2.41, 24.98±2.78, 29.17±7.98 points; the DR lesions were more severe, the evaluation score were higher, and the difference was statistically significant ( F=1.535, P<0.01). Conclusion:Compared with the control group, the macular GCC, pRNFL thickness and RPC blood flow density of diabetic patients are significantly reduced; the "DR evaluation score" is increased, and it is related to the severity of DR.

Relationship between cerebrovascular disease and peripheral vascular disease in patients with type 2 diabetes mellitus / 中国基层医药

Objective:To compare the incidence of carotid artery and lower extremity arterial disease between patients with type 2 diabetes mellitus complicated by cerebrovascular disease and those with no cerebrovascular disease and investigate the risk relationship between diabetic peripheral vascular disease and cerebrovascular disease.Methods:A total of 133 patients with type 2 diabetes mellitus complicated by cerebrovascular disease who received treatment in the Department of Endocrinology, The First People's Hospital of Kunming, China between June 2015 and June 2016 were included in the observation group. Sixty-six type 2 diabetes mellitus patients with no cerebrovascular disease were included in the control group. The incidence and severity of carotid artery and lower extremity arterial disease were compared between the observation and control groups. Stepwise logistic regression was performed taking whether cerebrovascular disease exists as a dependent variable. The risk factors for developing cerebrovascular disease in patients with type 2 diabetes mellitus were investigated.Results:The number of patients who had carotid plague in the observation group was significantly higher than that in the control group [66.17% (88/133) vs. 42.42% (28/66)]. Cervical vascular disease in the observation group was severer than that in the control group. In the observation group, 24.81% (33/133) of patients had rough carotid intima, and 9.02% (12/133) of patients had no rough carotid intima. In the control group, 33.33% (22/66) of patients had rough carotid intima, and 24.24% (16/66) of patients had no rough carotid intima. There was significant difference in the incidence of rough carotid intima between observation and control groups ( χ2 = 14.140, P = 0.030). The proportion of patients who had lower extremity carotid plaque in the observation group was higher than that in the control group [72.93% (97/133) vs. 42.42% (28/66)]. Lower extremity arterial disease in the observation group was severer than that in the control group. In the observation group, 22.56% (30/133) of patients had rough intima of lower extremity arteries and 4.51% (6/133) of patients had no rough intima of lower extremity arteries. In the control group, 33.33% (22/66) of patients had rough intima of lower extremity arteries and 24.24% (16/66) of patients had no rough intima of lower extremity arteries. There was significant difference in the proportion of rough intima of lower extremity arteries between observation and control groups ( χ2 = 24.030, P < 0.001). Logistic regression analysis showed that age, glycosylated hemoglobin, and the presence of lower extremity vascular disease were the risk factors for cerebrovascular disease [95% CI = 1.098 (1.051 -1.146), 1.240 (1.015-1.515), 3.802 (1.094-13.212)]. Conclusion:Peripheral vascular disease in patients with type 2 diabetes mellitus complicated by cerebrovascular disease is severer than that in patients with type 2 diabetes mellitus but without cerebrovascular disease. Aging, poor blood glucose control and lower extremity vascular disease are the risk factors for developing cerebrovascular disease in patients with type 2 diabetes mellitus. Lower extremity vascular disease has a certain value for predicting the occurrence of cerebrovascular disease in patients with type 2 diabetes mellitus.

Changes of serum 25 hydroxyvitamin D 3 expression in diabetic patients and its correlation with macrovascular complications / 中国医师进修杂志

Objective:To analyze the changes of serum 25-hydroxyvitamin D 3[25-(OH)D 3] expression in diabetic patients and its correlation with macrovascular complications. Methods:Two hundreddiabetic patients admitted to Cangzhou Central Hospital from February 2018 to November 2019 were divided into macrovascular complications group (87 cases) and without macrovascular complicationsgroup (113 cases). According to the degree of 25-(OH)D 3 deficiency, 32 cases were divided into 25-(OH)D 3 normal group, 94 cases were mild deficiency group and 74 cases were moderate and severe deficiency group. At the same time, 168 outpatients were selected as control group. The levels of serum 25-(OH)D 3 were compared between diabetic group and control group, macrovascular complications group and without macrovascular complications group, and the correlation between the level of serum 25-(OH)D 3 and carotid intima-media thickness (IMT) was analyzed. Results:The level of serum 25-(OH)D 3 in diabetic group was lower than that in control group: (24.79 ± 3.02) μg/L vs. (39.18 ± 4.38) μg/L, the difference was statistically significant ( P<0.05). The level ofserum 25-(OH)D 3 in diabetic patients with macrovascular complications group was lower than that in without macrovascular complications group: (21.08 ± 2.64) μg/L vs. (27.65 ± 3.31) μg/L; while the IMT was higher than that without macrovascular complications group: (1.29 ± 0.13) mm vs. (0.93 ± 0.10) mm, the differences were statistically significant ( P<0.05). The incidence of macrovascular complications in 25-(OH)D 3 moderate and severe deficiency group was higher than that in 25-(OH)D 3 mild deficiency group and 25-(OH)D 3 normal group: 60.81%(45/74) vs. 40.43%(38/94), 12.50%(4/32), the difference was statistically significant ( χ2 = 21.896, P<0.05). The level of serum 25-(OH)D 3 in patients with diabetic macrovascular complications was negatively correlated with IMT ( r = -0.513, P<0.05). Conclusions:The level of serum 25-(OH)D 3 in diabetic patients is decreased, and the change of its concentration is related to the occurrence of macrovascular complications.

Comparação da eficácia da retinografia colorida e da angiografia fluorescente no diagnóstico da retinopatia diabética / Comparing efficacy of fundus photography and fluorescein angiography in the diagnosis of diabetic retinopathy

RESUMO Objetivo: Avaliar a efetividade da retinografia colorida e a da angiografia fluorescente no diagnóstico e no rastreio da retinopatia diabética. Métodos: Estudo retrospectivo, com base na análise de resultados de ambos os exames de 398 pacientes diabéticos. Resultados: Os resultados da angiografia coincidiram com os da retinografia em 77,4% dos casos, e não houve diferença significativa no estadiamento e na identificação da retinopatia pelos dois métodos. Conclusão: Não houve diferença significativa em relação à capacidade diagnóstica da doença pelos métodos descritos, demonstrando não existir benefício em indicar a angiografia como avaliação inicial do paciente diabético.

ABSTRACT Objective: To assess effectiveness of fundus photography and fluorescein angiography in diagnosis and screening of diabetic retinopathy. Methods: A retrospective study of 398 diabetic patients, based on analysis of results of both tests. Results: Results of fluorescein angiography and fundus photography coincided in 77.4% of cases, and there was no significant difference in staging and identification of retinopathy by both methods. Conclusion: There was no significant difference between both methods regarding the capacity to diagnose the disease, showing no benefit in indicating fluorescein angiography as initial assessment of diabetic patients.

Relationship between apolipoprotein E gene polymorphism and cerebral infraction in Chinese type 2 diabetes mellitus patients / 中华检验医学杂志

Objective@#To investigate the relationship between apolipoprotein E (APOE) gene polymorphism and cerebral infraction (CI) in Chinese type 2 diabetes mellitus (T2DM) patients.@*Methods@#This study included 245 samples of T2DM patients without cerebral infraction (CON group) (Male/Female, 128/117) and 270 samples of T2DM patients with cerebral infraction (CI group)(Male/Female, 145/125) from the department of endocrinology and neurology utilizing real-time fluorescence quantitative PCR technique. The t test and χ2 test were used to compare the differences between the two groups.@*Results@#Patients with a history of hypertension in the CI group (84.12%) were significantly higher than those in the CON group (70.42%) (χ2=15.91, P<0.05).The systolic blood pressure (142.78±20.52)mmHg of the CI group was significantly higher than that of the CON group (133.89±18.58)mmHg (t=-5.16, P<0.05).Compared with CON group, the frequency of genotypes of ε2/ε3 and ε3/ε4 in CI group was significantly higher, while the frequency of ε3/ε3 genotype was significantly lower (χ2=11.48, P<0.05); the allele frequency of APOE ε4 was higher while ε3 was lower in CI group than that in CON group (χ2=7.00, P<0.05). Logistic regression analysis showed that hypertension history (OR=1.95, P<0.05), high systolic blood pressure (OR=1.02, P<0.05), APOE genotypes of ε2/ε3 (OR=2.08, P<0.05) and ε3/ε4 (OR=1.85, P<0.05) were independent risk factors for cerebral infarction in T2DM patients.@*Conclusion@#The polymorphism of APOE gene may be related to cerebral infraction in Chinese T2DM patients.

Rubeosis faciei diabeticorum is not associated with oxidative stress and skin autofluorescence

Abstract Background Rubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. Objective Examine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . Methods Patients diagnosed with Type 2 diabetes mellitus (n = 32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. - Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p ≤ 0.05 was considered statistically significant. Results There was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ = 0.398, p = 0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. Study limitations This is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. Conclusions The results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.

Diagnostic value of platelet count ,plasma D‐dimer , antithrombin Ⅲ levels and UACR for microvascu‐lar disease in type 2 diabetes mellitus／ / 心血管康复医学杂志

To explore diagnostic value of platelet count (PLT) ,plasma D– dimer (D‐D) , antithrombin Ⅲ(AT‐III) levels and UACR for microvascular disease (MVD) in type 2 diabetes mellitus (T2DM).Methods : A total of 284 T2DM patients treated in our hospital were divided into no MVD group (n＝144) and MVD group (n＝140) according to MVD condition .Another 120 healthy people were enrolled as healthy contrrol group .Levels of PLT ,plasma D‐D and AT‐Ⅲ,unine microalbuminuria (UMA) and creatinine (UCr) and UMA／UCr ratio (UACR) were measured and compared a‐mong all groups .The diagnostic value of combined detection of PLT ,plasma D‐D and AT‐Ⅲ levels and above triple detec‐tion combined UACR for MVD in T2DM were analyzed.Results : Compared with healthy control group ,there were signif‐icant reductions in levels of PLT [ (212.34 ± 51.23)×109／L vs.(116.46 ± 46.43)×109／L vs.(98.48 ± 35.66)× 109／L] and plasma AT‐III [(103.54 ± 7.23)% vs.(99.52 ± 4.24)% vs.(75.34 ± 5.31)%] ,and significant rise in levels of plasma D‐D [ (0.31 ± 0.16) mg／L FEU vs.(0.85 ± 0.33) mg／L FEU vs.(1.08 ± 0.52) mg／L FEU] and UCr [ (3.36 ± 1.56) mmol／L vs.(4.51 ± 1.79) mmol／L vs.(12.31 ± 5.12) mmol／L] in no MVD group and MVD group . And levels of PLT and plasma AT‐III of MVD group were significantly lower than those of no MVD group ,plasma D‐D and UCr levels of MVD group were significantly higher than those of no MVD group ( P＜ 0.01 all).Compared with healthy control group ,no MVD group ,there were significant rise in levels of UACR [ (11.25 ± 5.02) mg／mmol vs. (10.01 ± 4.39) mg／mmol vs.(59.89 ± 16.32) mg／mmol] , UMA [ (38.25 ± 17.22) mg／mmol vs.(41.11 ± 18.53) mg／L vs.(722.32 ± 101.54) mg／L] in MVD group ,and UACR of no MVD group was significantly lower than that of health control group (P＜0.05 or 0.01).Compared with single UACR detection and triple combined detection of PLT ,plasma D‐D and AT‐Ⅲ levels ,there were significant rise in sensitivity (85.51% vs.87.82% vs.90.33%) ,specificity (90.54%vs.85.32% vs.94.32%) and accuracy (82.33% vs.84.56% vs.90.21%) in triple detection combined UACR ( P＝0.001 all).Conclusion :Combined detection of PLT ,plasma D‐D and AT‐Ⅲ levels with UACR are significanly superior to combined detection for screening MVD in T2DM.

Research progress on the relationship between complement system and diabetic microangiopathy / 中国医师杂志

Diabetic microangiopathy is an vital reason of disabling and death in patients with diabetes.Long-term hyperglycemia and insulin resistance in type 2 diabetes mellitus can be involved in the formation of microangiopathy by aggravating mitochondrial damage,inflammation,and protein kinase C/glycosylation end product pathways.Besides,in recent years,several studies have shown that the activation of complement system plays an important role in the progression of diabetic vascular disease (including diabetic microvascular and macrovascular disease).This review is about to discuss the role and mechanism of the complement system in the development of diabetes and its microandioathy.

Advances in vitamin D and microvascular complications of type 2 diabetes mellitus / 中国医师杂志

Increasing evidence suggests that vitamin D deficiency may play an important role in the pathogenesis of type 2 diabetes mellitus (T2DM).T2DM manifests as a result of insulin resistance,increased hepatic glucose production and β-cell failure.Vitamin D metabolites are thought to play an important role in increasing insulin sensitivity and facilitating insulin exocytosis which is mediated both by direct mechanism through the availability of vitamin D receptors in several tissues and indirect mechanism through the changes in calcium levels.Vitamin D has also been shown to decrease inflammatory cytokines which plays an important role in insulin resistance and β-cell apoptosis.Several studies have confirmed that vitamin D is closely related to the long-term complications of diabetes.Low levels of vitamin D can exacerbate diabetic peripheral neuropathy,nephropathy,and retinopathy.Although diabetic patients with vitamin D deficiency is widespread,the existence of vitamin D deficiency and diabetes complications is still controversial,this article will review the relationship between vitamin D and the microvascular complications of T2DM.

Application of resistant exercise combined with Buerger exercise in patients with diabetic foot / 中国基层医药

Objective To investigate the application of resistive exercise combined with Buerger exercise in lower extremity vascular disease of type 2 diabetes mellitus .Methods According to the order of admission ,120 type 2 diabetes mellitus patients with lower extremity vascular disease were randomly divided into resistance exercise group ,Buerger exercise group and combined exercise group ,with 40 cases in each group .The resistance exercise group was given resistance exercise ,the Buerger exercise group was given Buerger exercise ,and the combined exercise group was given resistance exercise combined with Buerger movement .The changes of self -inductance ,ABI and DAWV of the three groups were observed .Results The clinical symptoms of the three groups were significantly reduced ( the resistance exercise group:markedly effective in 10 cases,effective in 14 cases;the Burger exercise group:markedly effective in 15 cases,effective in 17 cases;the combined exercise group: markedly effective in 22 cases,effective in 13 cases),the effective rate of the combined exercise group was higher than that of the resistance exercise group and Buerger exercise group ( the resistance exercise group:60.0％;the Burger exercise group:80.0％;the combined exercise group:87.5％,χ2 =11.333,P <0.05).The ABI of the three groups were higher than those before treatment,and the ABI ratio of the combined exercise group [(0.933 ±0.113)]was higher than that of the resistance exercise group[(0.866 ±0.112)] and the Buerger exercise group[(0.888 ±0.111)](t=1.796,2.663,all P<0.05 ) .The DAWV of the three groups increased compared with those before treatment , and the DAWV of the combined exercise group[(7.023 ±0.535)cm/s]was higher than that of the resistance exercise group [(6.633 ± 0.552)cm/s] and the Buerger exercise group [(6.772 ±0.435) cm/s] (t =2.302,3.209,all P <0.05). Conclusion Resistant exercise combined with Buerger exercise is helpful to improve the blood flow velocity and blood flow in the lower extremity vessel of patients with diabetic lower limb vascular disease , and can improve the self-sensitization symptoms of peripheral neuropathy in patients .

The relationship between the levels of serum cystatin C,lipoprotein associated phospholipase A2 and lower limb vascular disease in type 2 diabetes mellitus patients / 中国基层医药

Objective To explore the correlation between serum cystatin C,lipoprotein associated phospho-lipase A2 (LP-PLA2) and lower limb vascular disease in patients with type 2 diabetes mellitus.Methods From August 2014 to December 2016,a total of 187 type 2 diabetic patients in Weihai Central Hospital were selected. According to the ankle brachial index (ABI),the patients were divided into without lower limb vascular disease group (SDM group,85 cases) and with lower limb vascular disease group (T2DM+LLVD group,102 cases).Meanwhile,82 healthy people were selected as control group.The cystatin C,LP-PLA2,hemoglobin (HbAlc),triglyceride,total cholesterol,high density lipoprotein cholesterol ( HDL-C) and low density lipoprotein cholesterol ( LDL-C) were calculated.Results Compared with the control group [(0.788 ±0.084)mg/L],the cystatin C was significantly high-er in the SDM group[(0.913 ±0.135)mg/L] and the T2DM +LLVD group[(1.114 ±0.225)mg/L],and the difference was statistically significant (t＝5.511,9.121,all P＜0.01).The cystatin C in T2DM+LLVD group was higher than that in the SDM group ( t ＝7.209,P ＜0.01 ).Compared with the control group [( 342.76 ± 33.49)ng/mL],LP-PLA2 was significantly higher in the T2DM+LLVD group[(513.54 ±94.26)ng/mL],and the difference was statistically significant ( t ＝11.428,P＜0.01 ).Compared with the SDM group [( 352.28 ± 67.82)ng/mL],the cystatin C and LP-PLA2 levels were significantly higher that in the T2DM+LLVD group,and the difference was statistically significant (t＝7.209,13.181,all P＜0.01).Conclusion Cystatin C and LP-PLA2 play important roles in type 2 diabetic patients with lower limb vascular disease.Cystatin C and LP -PLA2 may become the forecast indicators in type 2 diabetic patients with lower limb vascular disease.

Associação entre doença celíaca e complicações do diabetes em pacientes com diabetes mellitus tipo 1: revisão sistemática / Association of celiac disease and complications of diabetes in type 1 diabetes mellitus patients: sistematic review

Devido à genética comum e à interação entre fatores ambientais e imunológicos, os pacientes com diabetes mellitus tipo 1 possuem um maior risco de desenvolverem outras doenças autoimunes, como a doença celíaca. O objetivo do trabalho foi avaliar a associação entre a doença celíaca e a presença de complicações do diabetes em pacientes com diabetes mellitus tipo 1. Foi realizada uma revisão sistemática da literatura, empregando as bases de dados PubMed, Web of Science, SciELO e LILACS. Foram estabelecidos como critérios de elegibilidade: estudos observacionais originais redigidos em português, inglês ou espanhol, que avaliaram a associação entre a doença celíaca e a presença de complicações do diabetes em pacientes com diabetes mellitus tipo 1. O processo de busca resultou em 3.651 artigos, e 13 foram incluídos no estudo. As principais complicações do diabetes avaliadas nos estudos selecionados foram nefropatia (34,8%) e retinopatia (26,1%), seguidas de hipoglicemia (13,0%), níveis reduzidos de HDL-colesterol (8,7%), neuropatia periférica (4,3%), aterosclerose subclínica (4,3%), doença cardiovascular (4,3%) e cetoacidose (4,3%). Para os níveis reduzidos de HDL-colesterol, doença cardiovascular, aterosclerose subclínica e neuropatia periférica, 100% dos estudos encontraram associação entre a doença celíaca e a presença destas complicações do diabetes. Com relação à retinopatia, nefropatia e hipoglicemia, 50%, 37,5% e 33,3% dos estudos encontraram associação, respectivamente, enquanto que nenhum estudo encontrou associação entre a doença celíaca e a cetoacidose. Portanto, foi verificada associação entre a doença celíaca e a presença de complicações do diabetes em pacientes com diabetes mellitus tipo 1.(AU)

Due to common genetics, and to interaction between environmental and immunologic factors, patients with type 1 diabetes mellitus have a higher risk to develop other autoimmune diseases, such as celiac disease. The aim of this study was to evaluate the association between celiac disease and the presence of complications of diabetes in patients with type 1 diabetes mellitus. A systematic review of literature was performed, using PubMed, Web of Science, Scielo and Lilacs databases. Eligibility criteria were: original observational studies written in Portuguese, English or Spanish, which evaluated the association between celiac disease and the presence of diabetes complications in patients with type 1 diabetes mellitus. The research resulted in 3651 papers, and from these, 13 were included in the study. The main complications of diabetes evaluated in the studies selected were nephropathy (34.8%) and retinopathy (26.1%), followed by hypoglycemia (13.0%), lower levels of HDL cholesterol (8.7%), peripheral neuropathy (4.3%), subclinical atherosclerosis (4.3%), cardiovascular disease (4.3%), and ketoacidosis (4.3%). Regarding lower levels of HDL cholesterol, cardiovascular disease, subclinical atherosclerosis, and peripheral neuropathy, 100% of the studies found an association between celiac disease and the presence of these complications of diabetes. Regarding retinopathy, nephropathy and hypoglycemia, 50%, 37.5% and 33.3% of the studies found some association, respectively, while none of the studies detected any association between celiac disease and ketoacidosis. Therefore, an association between celiac disease and the presence of diabetes complications in patients with type 1 diabetes mellitus was observed.(AU)

The significance and risk factor analysis of homocysteine in diabetic patients with macroangiopathy / 中华检验医学杂志

Objective To investigate the significance of serum homocysteine (HCY) level in the patients with diabetic macroangiopathy, and analyze the related risk factors.Methods Case control study.279 diabetics (male 198, female 111) aged 59.6(55.0-67.0) were selected in Shanghai Zhongshan Hospital from May 2015 to February 2016.According to the medical history and Carotid intima-media thickness, they were divided into carotid artery disease group (137 cases), cardiovascular disease group (197 cases) and cerebrovascular disease group (29 cases).We detected veinal blood HCY , fasting blood glucose, glycated albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, L-, gamma glutamyl transferase, urea nitrogen, creatinine, uric acid, cholesterol, three triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, glycosylated hemoglobin and albumin , creatinine in urine.The groups were compared with Mann-Whitney U test and χ2 test;Pearson correlation analysis was used to determine the correlations between HCY and other indicators;logistic regression model was used to analyze the risk factors of diabetic macroangiopathy and its subclasses;ROC curve was used to analyze the diagnostic value of HCY and uric acid in diabetic macroangiopathy.Results HCY in diabetic with macroangiopathy group was significant hiher than that in diabetic without macroangiopathy group 10.40(8.50-12.48) μmol/L 9.10(7.50-10.70) μmol/L, P<0.01).The incidence of diabetic macroangiopathy (χ2=7.030, P=0.030) and carotid artery lesions (χ2=7.258, P=0.027) was different in patients with different HCY levels.The correlation coefficients of HCY with urea nitrogen, creatinine, uric acid, urinary albumin/creatinine and estimated glomerular filtration rate (eGFR) were 0.340, 0.248, 0.278, 0.133,-0.369 (P<0.05), respectively.HCY was a risk factor for diabetic macroangiopathy, carotid plaque and cardiovascular disease;HCY, age and uric acid were independent risk factors for some of the diabetic macroangiopathy (P<0.05);HCY and UA had a certain diagnostic value for diabetic macroangiopathy(P<0.05).Conclusions Serum HCY is a risk factor for diabetic macroangiopathy, and detection of HCY levels will contribute to the diagnosis and prevention of the disease.

Establishment of rat model with diabetes mellitus and concomitant periodontitis and the carotid artery lesions in the model rats / 中华口腔医学杂志

Objectives@#To establish SD rat model with type 2 diabetes mellitus (DM) and concomitant chronic periodontitis (CP) and to evaluate the influence of periodontitis on the vascular lesions of type 2 diabetes rats.@*Methods@#Totally 241 clean level SD rats were randomly divided into four groups, group A (normal control, NC, n=27), group B (DM, n=34), group C (CP, n=90) and group D (DM+CP, n=90). The rats of DM group were fed with high-fat and high-sugar diet for 8 to 10 weeks, and then were multiply injected with small dose streptozotocin under the condition of ice bath. Blood sugar levels after the injection were dynamically monitored at 72 h, 1 week, 2 weeks and 4 weeks, respectively. The CP model was established by means of ligation. Bilateral maxillary first and second molars were selected and ligated using 0.2 mm orthodontic wires binding with 4-0 surgical suture soaked with Porphyromonas gingivalis (Pg) suspension. After a period of 14 weeks, all the rats were put to death. Maxillary samples were subjected to methylene blue staining to observe alveolar bone loss. Bilateral carotid artery specimens were collected. The left carotid artery specimens were used to detect the prevalence of Pg using quantitative real-time PCR. The right carotid artery specimens were used to observe pathological changes.@*Results@#Blood sugar levels of rats in group B and D increased and changed sharply after Streptozotocin injection with in 1 week. Symptoms of 'more drink, more food and body weight loss’ appeared. The fasting blood glucose (FBG) was more than 7.8 mmol/L and (or) the random blood glucose (RBG) was more than 17.8 mmol/L. Both FBG and RBG became stable after 2 to 3 weeks. Levels of HbA1C in group B and D ([7.32±0.45]%, [9.41±0.45]%) were significantly higher than that of group A ([4.02±0.45]%) (P<0.01). Rats of group D were observed the most severe bone loss showing wider interdental space and furcation involvement. Pathological results of carotid artery tissues of group D showed the worst lesions including thinning and calcification of vessel walls, and breaking down or disappearance of elastic fibers. The prevalences of DNA of Pg in groups of A, B, C and D were 3/7, 3/7, 6/7 and 7/7, respectively. The bacteria numbers detected by quantitative real-time PCR in groups C and D were significantly higher than that of groups A and B (P<0.01).@*Conclusions@#Rat model of type 2 DM with periodontitis was successfully established in the present study. Carotid artery specimens from DM+CP model rats showed typical vascular lesions such as calcification and fiber disorders. Pg was found in all carotid specimens and the highest bacteria numbers were detected in the composite model rats. The Pg might play a role in the progress of diabetes vascular lesions.

99Tcm-MIBI Gated Myocardial Perfusion Imaging in Evaluating Coronary Microangiopathy in Patients with Diabetic Mellitus / 中国医学影像学杂志

Purpose To evaluate the clinical guiding value of 99Tcm-methoxyisobutylisonitrile gated myocardial perfusion imaging (99Tcm-MIBI G-MPI) in diagnosing the coronary microangiopathy in patients with diabetic mellitus.Materials and Methods Sixty patients with clinical confirmed coronary microvascular angina were selected and assigned into two groups,with 26 patients (with diabetes mellitus) in group A and 34 patients in group B (without diabetes mellitus).The region,extent and range of coronary microangiopathy was detected by 99Tcm-MIBI G-MPI,and the difference of myocardial ischemia between the two groups was statistically analyzed.Results The ratio of abnormal myocardial perfusion in group A was significantly higher than that in group B (96.15％ vs.73.53％,x2=5.43,P＜0.05);the total number of abnormal coronary branches in group A was significantly larger than that in group B (82.67％ vs.62.67％,P＜0.05);the total number abnormal perfusion segments in group A was significantly larger than that in group B (P＜0.05),and the abnormal perfusion segments number of anterior wall,septum,apical region and inferior wall in group A was significantly larger than that ingroup B (P＜0.05);the rate of abnormal perfusion at single coronary supplying region in group A was significantly lower than that in group B (P＜0.05).Conclusion 99Tcm-MIBI G-MPI is of great clinical significance for diagnosing coronary microangiopathy and evaluating myocardial ischemia in patients with diabetes mellitus.

Feasibility of umbilical cord blood stem cell transplantation for the treatment of diabetic lower limb ischemia / 中国组织工程研究

BACKGROUND:Diabetic lower limb ischemia is prone to involve distal lower limb arteries, and a conventional treatment is often unable to obtain the ideal effect. OBJECTIVE:To investigate the effect and safety of umbilical cord blood stem cel transplantation in the treatment of diabetic lower limb ischemia. METHODS: A diabetic rat model of lower limb ischemia was established, and along the femoral artery, five points were selected for injection of human umbilical cord mesenchymal stem cel suspension, 20 μL per point. At 1, 2, 4 weeks after transplantation, transcutaneous oxygen pressure, vascular density and vascular endothelial growth factor level in the ischemic region, and incidence of adverse reactions were recorded. RESULTS AND CONCLUSION:At 1, 2 and 4 weeks after transplantation, the transcutaneous oxygen pressure, vascular density and vascular endothelial growth factor level in the ischemic region were found increasing, which were significantly different from those before transplantation (P < 0.05). At different time after transplantation, al animals had no inflammatory reactions such as skin bleeding and dermatitis, and local red, sweling, hot, pain, and had no tumor-like growth in organs. These findings indicate that umbilical cord blood stem cel transplantation can safely and significantly improve symptoms of diabetic lower limb ischemia, which has certain application feasibility. Cite this article:Xie LH, Xing L, Zheng H. Feasibility of umbilical cord blood stem cel transplantation for the treatment of diabetic lower limb ischemia. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(1):78-82.

Lipopolysaccharides priming mesenchymal stem cells accelerate diabetic wound healing via exosomes / 解放军医学杂志

Objective To study the therapeutic effect of exosome derived from lipopolysaccharides (LPS) priming mesenchymal stem cells (MSCs) for diabetic wound healing. Methods Human umbilical cord MSCs were treated with LPS (100ng/ml) for 2 days, the supernatant were then collected, and exosomes were harvested by density gradient centrifugation and identified. Diabetic cutaneous wounds were prepared and the animals were divided into the following three groups: control group, untreated MSCs derived exosome (un-exosome) treatment group and LPS primed MSCs derived exosome (LPS-exosome) treatment group. Exosomes (60μg) were injected dispersively into the wound edge daily for 10 days. After treatment, the therapeutic results were evaluated by gross observation of the wounds, the expression levels of inflammation related factors and macrophage subtype markers in the injured sites were detected by qRT-PCR at day 3, 7 and 14 after treatment. Results Compared with control group, the diabetic wound healing was obviously improved in LPS-exosome treatment group after treatment for 7 and 14 days, with faster wound close, depressed expression of pro-inflammatory factors IL-1, IL-12 and M1 macrophage surface marker iNOS, and upregulation of anti-inflammatory factors IL-10, TGF-β and M2 macrophage surface marker CD163, the differences were significant (P<0.05). Conclusions LPS-exosome may balance macrophage plasticity, restrain chronic inflammation and accelerate diabetic cutaneous wound healing.