Intervention effect of systemic nutrition combined with rhythmic exercise on diabetes mellitus patients complicated with cardiovascular disease / 公共卫生与预防医学

Objective To investigate the intervention effect of systemic nutrition combined with rhythmic exercise on diabetes and cardiovascular complication risk. Methods Sixty subjects with diabetes history (≥3 years) were selected to receive the combined intervention of systemic nutrition and rhythmic exercise every day for 60 days. Before and after the intervention, the bioelectric body scanning, arteriosclerosis detection, diabetes risk assessment and other techniques were used to examine the 60 participants. Results The blood glucose and blood lipid levels, the activity value of relevant organs, and cardiovascular complications risk related indicators of most subjects after intervention were significantly improved compare with those before intervention. Conclusion The combination of systemic nutrition and rhythmic exercise demonstrates significant effects on improving glucose metabolic level and reducing cardiovascular complication risks in people with abnormal glucose metabolism.

Clinical correlates of hypotension in patients with acute organophosphorus poisoning / 世界急诊医学杂志（英文）

@#BACKGROUND: The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning (AOPP). METHODS: In this retrospective cohort study, we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals. Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension. We also evaluated the association between clinical parameters (including hypotension) and in-hospital mortality. RESULTS: The incidence of hypotension in AOPP patients was 16.4%. Hypotensive patients showed significantly higher in-hospital mortality (1.1% vs. 39.9%, P<0.001). Advanced age (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.08-1.44), history of diabetes (OR 2.65, 95% CI 1.14-5.96), and increased white blood cell count (OR 1.06, 95% CI 1.03-1.09), plasma cholinesterase (OR 0.91, 95% CI 0.84-0.94), plasma albumin (OR 0.88, 95% CI 0.85-0.92), serum amylase (OR 1.01, 95% CI 1.01-1.02), and blood pH (OR 0.64, 95% CI 0.54-0.75) were significantly associated with hypotension. After adjusting for potential confounders, hypotension was associated with increased in-hospital mortality (hazard ratio 8.77-37.06, depending on the controlled variables). CONCLUSIONS: Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality. Advanced age, history of diabetes, and changes in laboratory parameters were associated with hypotension in AOPP patients.

Dapagliflozin, a sodium glucose cotransporter 2 inhibitors, protects cardiovascular function in type-2 diabetic murine model

Diabetes mellitus and its complications are major international health problems in which there are many limitations to the orthodox approaches in the treatment. Sodium glucose cotransporter 2 (SGLT2) inhibitors are a new class of diabetic medications, with a different mechanism of action that may reduce risk of cardiovascular complications. To evaluate the effect of SGLT2 inhibitor monotherapy on cardiovascular complications in patients with type-2 diabetes and to compare its effect with the first-line therapy, metformin. Eighty rats divided into four groups were used: nondiabetic, diabetic nontreated, diabetic ? met and diabetic ? dapa. At the end, the arterial blood pressure and cardiac performance were assessed. Glycemic index, lipid profile, total antioxidant capacity, malondialdehyde, tumour necrosis factor a were measured. DNA changes were assessed from the hearts and aortae. Aortic tissue changes recorded using haematoxylin and eosin, Masson trichrome and iNOS immune stain. Glycemic index, lipid profile, oxidative stress and inflammatory parameters were significantly improved in both metformin and dapagliflozin treated groups with significant improvement in blood pressure and cardiac performance. Also, there were noticeable significant reduction in DNA fragmentation in aortic and cardiac tissues and reduction in collagen deposition and iNOS expression in aortic tissue. Dapagliflozin treatment results’ significantly surpassed improvement of metformin treatment nearly in all parameters. Total genomic DNA extraction proved that SGL2 inhibitor (dapagliflozin) has superior glycemic control and cardiovascular protective effect over metformin especially in type-2 diabetes with high fat intake.

Cardiovascular Complication after Kidney Transplantation

Patient mortality after kidney transplantation continues to be a major clinical challenge, with approximately 1 in 5 recipients dying within 10 years of engraftment. Cardiovascular disease (CVD) is the most common cause of death after the 1-year posttransplant and it has been estimated that the risk of cardiovascular events is 50-fold higher than in the general population. Because of this, post transplant outcomes are substantially influenced by cardiovascular disease. The presence of both traditional and non-traditional risk factors contributes to this overwhelming burden of cardiovascular disease in patients with chronic kidney disease (CKD)

Association of Adiponectin 45T/G Polymorphism with Diabetic Cardiovascular Complications in Korean Type 2 Diabetes

BACKGROUND: Adiponectin is an adipokine that regulates lipid and glucose metabolism and has been shown to have anti-inflammatory and anti-atherogenic effects. It also plays an important role in the development of cardiovascular disease (CVD). METHODS: This study evaluated the association between adiponectin 45T/G polymorphism and cardiovascular complication in type 2 diabetes in Koreans. RESULTS: The present study included 758 patients with type 2 diabetes. The distribution of the adiponectin 45T/G polymorphism was 3.56% (n = 27) for GG, 42.35% (n = 321) for TG, and 54.09% (n = 410) for TT in patients with type 2 diabetes. The prevalence of CVD was significantly higher in subjects with the GG + TG genotype compared to those with the TT genotype (17.5% vs. 9.8%, P = 0.002). The G allele was associated with a higher risk of CVD (P = 0.002). CONCLUSION: Our findings suggest that the adiponectin 45T/G polymorphism is associated with diabetic cardiovascular complication in type 2 diabetes.

The Association between Diabetic Retinopathy and Framingham Risk Score in Koreans with Type II Diabetes

PURPOSE: In this study, we compared the risk of cardiovascular complications between diabetic retinopathy (DR) groups based on the Framingham Risk Score. METHODS: Subjects 40 years of age or older were enrolled in the present study from September 2008 to September 2009. Five scales were used to evaluate the severity of DR for the most severely affected eye in each patient: no DR, mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). The first group included no DR patients and the second group included mild NPDR patients. The third group included moderate NPDR, severe NPDR and PDR patients. The Framingham Risk Score was analyzed among the groups to determine whether a difference in score existed. RESULTS: DR was found in 126 subjects. The first group included 403 subjects, the second group 22 subjects and the third group 104 subjects. The average Framingham Risk Score that appeared with increasing severity of DR was 10.89 ± 7.98 in the first group, 12.25 ± 10.84 in the second group and 13.25 ± 10.66 in the third group. The average difference between the first and third groups was statistically significant (p = 0.014). CONCLUSIONS: In our study, the Framingham Risk Score increased significantly with more severe DR (p = 0.042). Our results are useful when considering the easily accessible identification of DR and that cardiovascular disease is one of the main causes of death worldwide. However, confirming the exact causal relationship based on our results is difficult because the study design was cross-sectional and additional studies are necessary.

Regulation of miRNA in diabetes mellitus and its cardiovascular complications / 中华内分泌代谢杂志

miRNAs (microRNAs) are small RNA which regulate gene expressions at the post-transcriptional level.Recently studies have suggested that miRNA is associated with the development of diabetes mellitus and its complications.This artcle reviews the regulation of miRNA in diabetes mellitus and its cardiovascular complications,and the biomarkers' value and application of miRNA in the treatment of diabetes mellitus,aiming to develop new insight for the diagnosis and treatment of diabetes mellitus.

Prevalence and Clinical Characteristics of Aspirin Resistance in the Patients with Type 2 Diabetes Mellitus / 당뇨병

BACKGROUND: We examined the prevalence and clinical characteristics of aspirin resistance in the Korean patients with type 2 diabetes mellitus. METHODS: We studied 181 Korean patients with type 2 diabetes mellitus who were taking aspirin (100 mg/day for > or = 3 months) and no other antiplatelet agents. The VerifyNow System was used to determine aspirin responsiveness. Aspirin resistance was defined as an aspirin reaction unit (ARU) > or = 550. We measured the cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) to evaluate arteriosclerosis. The anthropometric parameters, electrocardiogram, blood pressure, fasting plasma glucose, lipid profiles, hemoglobin A1c, highly sensitive C-reactive protein (hsCRP), homocysteine, and microalbuminuria were measured in each patient. RESULTS: The prevalence of aspirin resistance in type 2 diabetic patients was 9.4% (17 of 181). Those who had aspirin resistance were older than those without aspirin resistance (64.6 +/- 10.6 vs. 59.8 +/- 8.1, P = 0.024). Aspirin resistance was not associated with fasting plasma glucose, total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol, hemoglobin A1c, hsCRP, homocysteine, microalbuminuria, ABI, CAVI, and body mass index. CONCLUSION: Prevalence of aspirin resistance in the Korean patients with type 2 diabetes mellitus was 9.4%. Although aspirin resistance was associated with old age, we could not find any good clinical parameter to predict it. Therefore, aspirin resistance should be evaluated in diabetic patients taking aspirin for prevention of cardiovascular complications.

Case Report On Haemolytic Uraemic Syndrome And Cardiovascular Complication

A 66 year old Caucasian female presented with haemolytic uraemic syndrome (HUS) following a prodrome of diarrhoea. During the course of her illness, she developed acute heart failure secondary to myocardial ischaemia. Cardiovascular complications associated with HUS involving children have been reported in the literature. The mortality of adult patients with acute heart failure is significantly higher even with the initiation of therapeutic plasma exchange.

Body Weight, Cardiovascular Risk Factors, and Self-Efficacy of Diabetic Control among Obese Type II Diabetic Patients / 간호학회지

PURPOSE: The purpose of this study was to examine the effects of problem solving nursing counseling and walking exerciseon weight loss, cardiovascular risk factors, and self-efficacy of diabetic control among obese diabetic patients. The Polar heart rate monitor was used for walking exercise to utilize the Biofeedback mechanism. METHOD: Fifty nine diabetic patients were conveniently placed into experimental (n=35) and control groups (n=24). The experimental group participated inweekly nursing counseling for 12 weeks and was encouraged to do walking exercise using a Polar monitor. The control group remained in the same treatment as before. The data wascollected from November 2003 to August 2004 and analyzed using t-tests and ANCOVAs. RESULTS: After 12 weeks, the participants in the experimental group reported significantly decreased body weight (p=.004) and total scores on theParma scale (p=.001). While the participants in the control group reported significantly increased levels of blood triglyceride (p=.046) and HDL (p=.018). CONCLUSION: Based on the findings, we concluded that problem focused nursing counseling with intensified walking exercise could reduce the risk of cardiovascular complications and body weight among obese diabetic patients. Future research to explore the long-term effects of nursing counseling on diabetic complications is warranted.

Glutathione and glutathione peroxidase in type 2 diabetic patients.

Objectives: Hyperglycemia is claimed to cause oxidative stress in diabetic (DM) patients. The influence of free radical production by hyperglycemia may exacerbate the cardiovascular complications in diabetes. However, the effects of glycemic control and cardiovascular complications is diabetes on oxidative stress parameters have been not fully studied. This study compared the red cell glutathione (GSH) level and glutathione peroxidase (GPx) activity in fairly controlled typed 2DM(Fasting plasma glucose {EPG}-<180 mg/dl) poorly-controlled type 2 DM (FPG>180 mg/dl), and type 2 DM complicated with coronary heart disease (CHD) with that in a normal healthy group (FPG <110 mg/dl). Materials & Methods : GSH level and GPx activity were determined in the red cells of 19 subjects with poorly controlled type 2 DM, 26 subjects with fairly controlled type 2 DM, and 20 subjects with type 2 DM complicated CHD with that of 20 healthy subjects with normal plasma glucose level matched for age and gender who served as a control group. In all groups of DM these oxidative stress parameters were compared to a control group by one-way ANOVA test. The association between these parameters and FPG was to a control group by one-way ANOVA test. The association between these parameters and FPG was determined using the Pearson product moment correlation. Results : The red cell GSH levels were significantly lower in all types of diabetes compared with those of age-matched normal control subjects (p<0.05).Red cell GPx activity was significantly increased only in the poorly controlled type 2 DM and type 2DM with CHD (<0.05). The decrement of red cell GSH may be due to the higher consumption of GSH for the increasing of GPx activity or there is a reduction or the pentose phosphate pathway that stimulated by insulin resulting in lowered GSH recycling. The association between FPG and GSH or GPx activity in all subgroups of type 2 diabetic patients compared with normal healthy subjects showed no correlation. Conclusion : These findings suggested that type 2 DM patients were susceptible to oxidative stress and higher blood glucose level in poorly controlled type 2DM and type 2 DM complicated with CHD had an association with free radical-mediated lipid peroxidation. Therefore, any means that can reduce oxidative stress may be beneficial for the prevention or slowing of progression of cardiovascular complication in these types of diabetic patients.

Clinical Profile of Duchenne Muscular Dystrophy

OBJECTIVE: To evaluate clinical features in general and possible complications in Duchenne muscular dystrophy (DMD) which could be used for comprehensive rehabilitation management. METHOD: One hundred and seventy-two patients with DMD were followed over 3 year period to provide clinical profile causing impairment and disability. We measured height, weight and manual muscle testing (MMT) when the patients visited the hospital. And we could measure pulmonary function, electrocardiogram (EKG), and intelligence quotient (IQ) test in cooporative patients. RESULTS: The median height and weight of DMD boys were normally distributed before age 12, but during the second decade height was markedly reduced, and weight was no longer normally distributed. The MMT measurement showed loss of strength in a fairly linear fashion according to increasing age, and extensor of lower extremities were weaker than flexors showing typical contractures of legs. There was a direct relationship between pulmonary function and MMT scores of upper extremities. There was a high occurrence (40%) of abnormal EKG, but none of the patients had a history of cardiovascular complication. DMD children suffered wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression, and 50.9% of them were below average on the IQ test. CONCLUSION: These data on DMD subjects provide clinicians with useful information regarding the prevalence and severity of measurable impairment at different stages of the disease.

Evolução clínica de portadoras de estenose mitral no ciclo gravídico-puerperal / Clinical evolution of women with mitral valve stenosis during pregnancy, delivery and puerperium

Objetivo - Estudar a evoluçäo clínica de portadoras de estenose mitral no ciclo gravídico-puerperal que iniciaram a gravidez em classe funcional (CF) I/II. Métodos - Noventa e três mulheres, divididas em três grupos: Grupo GE - 30 gestantes portadoras de estenose mitral com média de idade de 27,9 anos. 26(86,7%) apresentavam sobrecarga atrial esquerda e nove (30%) ventricular direita no eletrocardiograma. A área valvar mitral ao ecodopplercardiograma variou entre 0,7 a 1,9 (1,26) cm*. Grupo GN - 32 gestantes näo cardiopatas, com média de idade de 25,5 anos com eletrocardiograma e área valvar mitral ao ecodopplercardiograma normais. Grupo EM - 31 portadoras de estenose mitral, näo grávidas com média de idade de 25 anos. Dezenove (61,3%) apresentavam sobrecarga atrial esquerda e quatro (13%) sobrecarga ventricular direita no eletrocardiograma. A área valvar mitral variou entre 0,50 a 1,80 (média = 1,19) cm*. Em cada consulta foram anotados os dados sobre CF e complicaçöes. As complicaçöes investigadas foram congestäo pulmonar, endocardite infecciosa, arritmia cardíaca e tromboembolismo. Resultados - Vinte e seis (86,7%) pacientes do grupo GE modificaram a CF: 16 evoluíram para CF III e 10 para IV, no grupo GN, 18 (56,2%) pacientes evoluíram de CF I para II no decorrer da gestaçäo e no grupo EM, cinco (16%) evoluíram da CF I/II para III durante o estudo. Arritmia cardíaca, endocardite infecciosa näo foram registradas. Fenômeno tromboembólico foi identificado em um (3,2%) caso no grupo EM. Näo houve mortalidade. Conclusäo - A grande maioria das gestantes portadoras de estenose mitral, que iniciaram a gravidez em CF I/II evoluíram para CF III/IV, no decorrer da gestaçäo. Medidas como repouso, farmacoterapia e avalvoplastia por cateter-baläo contribuíram, na totalidade dos casos, para o termo da gestaçäo e ausência de mortalidade

Purpose The clinical evolution of women with mitral stenosis was studied during pregnancy, delivery and puerperium in inicial function (FCJ class I/II. Methods ­ Ninety-three women were divided in three groups. Group GE Pregnant women with mitral stenosis (n = 30, mean age 28 years); 26 (86.7%) patients had electrocardiographic signs of left atrial enlargement and nine (30%) had signs of right ventricular hypertrophy. The mitral valvar area was between 0.7 and 1.9 (mean = 1.26) cm2 at echod opplercardiogram, Group GM Normal pregnant women (n = 32; aged 25.4 years), the electrocardiogram and echodopplercardiogram were normal. Group EM - non pregnant patients, with mitral stenosis (n = 31.33 years); 19 (61,3%) had left atrial enlargement andfour (13%) had right ventricular hypertrophy. The mitral valvar area between 0.50 and 1.80 (mean = 1.19) cm2. The variables analyzed were FC and occurrence of the following complications. infective endocarditis, cardiac arrhythmias and thromboembolism. Results In GE group, 26 (86,7%) patients worsened the FC during gestation, 16 to FC III and 10 to FC IV. In GN group, 18 (56,2% ) patients changed from FC I to FC II during the gestation and in EM group 5 (16,2%) patients changed from FC I/II to III during the study. Cardiac arrhythmias and infective endocarditis were not observed; thromboembolic event was registered in one (3.2%) patients from EM group. There were no death in all groups. Conclusion ­ The large majority of pregnant with mitral stenosis that started pregnancy in FC I/II worsened to FC III/IV during gestation. Medical treatment and eventually balloon valvuloplasty were successfull measure to allow a full-term gestation without mortality