Prevalencia de diabetes, características epidemiológicas y complicaciones vasculares / Prevalence of diabetes, epidemiological characteristics and vascular complications

Resumen Objetivo: Estimar la prevalencia de diabetes en atención ambulatoria y describir sus características epidemiológicas, comorbilidades y complicaciones vasculares relacionadas. Método: Corte transversal que incluyó la totalidad de adultos afiliados a la prepaga del Hospital Italiano de Buenos Aires en marzo de 2019, Argentina. Resultados: La prevalencia global de diabetes resultó del 8.5% con intervalo de confianza del 95% (IC95%): 8.3-8.6 (12,832 de un total de 150,725 afiliados). El estrato etario con mayor prevalencia fue el grupo entre 65 y 80 años, con un 15.7% (IC95%: 15.3-16.1). Las personas con diabetes presentaban una media de edad de 70 años (desviación estándar: 14), el 52% eran mujeres, y los factores de riesgo cardiovasculares más frecuentemente asociados fueron: dislipidemia (88%), hipertensión arterial (74%) y obesidad (55%). En relación con el control metabólico, el 60% tenía al menos una hemoglobina glucosilada medida en el último año, siendo el 70% de estas menores al 7%. Casi el 80% tiene medido el colesterol vinculado a lipoproteínas de baja densidad (c-LDL) al menos una vez en los últimos dos años, de ellos el 55% presentaba un valor de c-LDL igual o menor a 100 mg/dl. Las complicaciones macrovasculares presentes en orden de frecuencia fueron: infarto agudo de miocardio (11%), accidente cerebrovascular (8%) y enfermedad vascular periférica (4%); mientras que las complicaciones microvasculares resultaron ser neuropatía diabética (4%) y retinopatía (2%). El 7% tuvo pie diabético, con menos del 1% de amputaciones. Conclusiones: La diabetes representa un problema prevalente, incluso en pacientes ancianos. Esta población sigue presentando un elevado riesgo cardiovascular, con escaso cumplimiento de objetivos terapéuticos.

Abstract Objective: To estimate prevalence of diabetes in outpatient care and to describe its epidemiological characteristics, comorbidities, and related vascular complications. Methods: Observational cross-sectional study which included all adults affiliated from a private insurance health plan on March 2019, at Hospital Italiano de Buenos Aires, from Argentina. Results: The global prevalence of diabetes resulted in 8.5% with 95% CI 8.3-8.6 (12,832 out of a total of 150,725 affiliates). The age stratum with the highest prevalence was the group between 65 and 80 years old with 15.7% (95% CI 15.3-16.1). People with diabetes had a mean age of 70 years (SD 14), 52% were women, and the most frequently associated cardiovascular risk factors were: dyslipidaemia (88%), arterial hypertension (74%) and obesity (55%). In relation to metabolic control, 60% had at least one glycosylated hemoglobin measured in the last year, 70% of which were less than 7%. Almost 80% have LDL measured at least once in the last 2 years, 55% of them had an LDL value equal to or less than 100 mg/dl. The macrovascular complications present in order of frequency were: acute myocardial infarction (11%), cerebrovascular accident (8%) and peripheral vascular disease (4%); while the microvascular complications were found to be diabetic neuropathy (4%) and retinopathy (2%). 7% had diabetic foot, with less than 1% amputations. Conclusion: Diabetes represents a prevalent problem, even in elderly patients. This population continues to present a high cardiovascular risk, with little compliance with therapeutic goals.

Clinical outcomes of MANTA vs suture-based vascular closure devices after transcatheter aortic valve replacement: An updated meta-analysis

Objective: A recently published randomized control trial showed different results with suture-based vascular closure device (VCD) than plug-based VCD in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). The learning curve for MANTA device is steep, while the learning curve for suture based VCD is shallow as the devices are quite different. In this meta-analysis, we have compared suture-based (ProGlide and Prostar XL) vs plug-based VCDs (MANTA). Methods: We performed a meta-analysis of all published studies (using PubMed/Medline and Cochrane databases) reporting the clinical outcome of plug-based vs suture-based VCDs in transfemoral TAVR patients. Results: We included nine studies with a total of 2865 patients (plug-based n ¼ 1631, suture-based n ¼ 1234). There was no significant difference in primary outcome of all bleeding when using plugbased as opposed to suture-based VCDs (RR 1.14 [0.62e2.06] I2 ¼ 72%). There was no significant difference in the incidence of secondary outcomes between two groups including major life threatening bleeding (RR 1.16 [0.38e3.58] I2 ¼ 65%), major vascular complications (RR 0.84 [0.35e2.00] I2 ¼ 55%), minor vascular complications (RR 1.05 [0.56e1.95] I2 ¼ 42%), pseudo aneurysm (RR 1.84 [0.11e29.98] I 2 ¼ 44%), stenosis-dissection (RR 0.98 [0.66e1.47] I2 ¼ 0%), VCD failure (RR 1.71 [0.96e3.04] I2 ¼ 0%), and blood transfusion (RR 1.01 [0.38e2.71], I2 ¼ 61%). Conclusion: Large bore arteriotomy closure with plug-based VCD was not superior to suture-based VCDs in this transfemoral TAVR population. There was very frequent use of secondary VCDs in suture-based VCD group which is not practical when using MANTA. Additional high-powered studies are required to determine the safety and efficacy of MANTA device.

Vascular complications in 305 severely ill patients with COVID-19: a cohort study

ABSTRACT BACKGROUND: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications (other than venous thromboembolism) are sparse. OBJECTIVE: To investigate the vascular complications in severely ill patients hospitalized with COVID-19 and their association with all-cause mortality. DESIGN AND SETTING: This cohort study was conducted at the Universidade Federal de São Paulo, Brazil. METHODS: All 305 consecutive patients diagnosed with COVID-19 and hospitalized in the intensive care unit (ICU) of a tertiary university hospital from April 2 to July 17, 2021, were included and followed up for 30 days. RESULTS: Of these, 193 (63.3%) were male, and the mean age was 59.9 years (standard deviation = 14.34). The mortality rate was 56.3% (172 patients), and 72 (23.6%) patients developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivors (28.5%) than in the survivors (17.3%) group and included disseminated intravascular coagulation (DIC, 10.8%), deep vein thrombosis (8.2%), acrocyanosis (7.5%), and necrosis of the extremities (2%). DIC (adjusted odds ratio (aOR) 2.30, 95% confidence interval (CI) 1.01-5.24, P = 0.046) and acrocyanosis (aOR 5.21, 95% CI 1.48-18.27, P = 0.009) were significantly more prevalent in the non-survivors than in the survivors group. CONCLUSION: Vascular complications in critically ill COVID-19 patients are common (23.6%) and can be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of the management of COVID-19. REGISTRATION: RBR-4qjzh7 (https://ensaiosclinicos.gov.br/rg/RBR-4qjzh7).

Clinical efficacy of artificial vascular replacement for external iliac artery dissection during renal transplantation / 中华器官移植杂志

Objective:To explore the clinical efficacy of treating external iliac artery dissection in renal transplantation by artificial vascular replacement.Methods:Four sudden intraoperative cases of external iliac artery dissection were selected.After removing vascular sutures, intimal arterial peeling blocked external iliac artery( n=3)and transplanted renal artery( n=1). Artificial vascular replacement of external iliac artery was performed using artificial vessels made from puffed polytetrafluoride ethylene(ePTFE). Secondary perfusion was performed in four transplanted kidneys for anastomosing with internal iliac artery. Results:One patient regained normal renal function within 1 week post-operation.Two cases had delayed graft function.Another case had delayed graft function plus acute rejection.After hemodialysis, renal function normalized at 2-3 weeks post-operation.During a follow-up period of(0.5-5.0)years, transplanted kidney function remained stable, blood supply, skin temperature and movement of operated lower extremities normalized.Conclusions:The incidence of vascular dissection of external iliac artery is not high during renal transplantation.However, the disease has a rapid and dangerous progression.The consequences of delayed intervention are quite serious.Treating external iliac artery dissection with renal transplantation may achieve satisfactory clinical outcomes.

Vascular complications caused by hyaluronic acid injection: a clinical analysis / 中华医学美学美容杂志

Objective:To analyze the epidemiological characteristics of vascular complications induced by hyaluronic acid facial injection.Methods:Patients with vascular complication induced by facial hyaluronic acid facial injection were collected in the Fourth Medical Center of the General Hospital of the Chinese People's Liberation Army from January 1, 2016 to October 1, 2021, including 5 males and 37 females. The age ranged from 16 to 70 (34±10) years. The clinical data, injection site, clinical symptoms and previous facial surgery history of the patients were analyzed and investigated.Results:Vascular complications occurred in 12 cases (28.6%). Nasolabial fold in 8 (19.0%) cases; Glabella in 6 (14.3%) cases; frontal part in 6 (14.3%) cases. There were 27 patients (64.3%) with a history of facial surgery. Furthermore, history of facial surgery had no effect on the clinical manifestations of vascular complications ( P>0.05). Among the 18 patients with visual impairment, 12 patients reported that the symptoms of ptosis, bulbar conjunctival congestion, and eye movement dysfunction had diminished after thrombolytic treatment, while 4 patients showed recovery to some extent in visual acuity. Likewise, 24 patients with blood circulation disorders were healed after treatment, with residual pigmentation and a slight scar left. Conclusions:Women aged 30 to 39 years old are the main target population of cosmetic surgery, as well as the most common population of vascular complications. Particular care should be taken in the nose, nasolabial fold, glabella and forehead areas of the operation. Patients with previous surgical history should be adequately informed before surgery, and postoperative observation time should be appropriately prolonged.

Management of vascular complications after kidney transplantation caused by donor derived infection: a report of 6 cases / 中华器官移植杂志

Objective:To summarize the institutional experiences of treating vascular complications caused by donor-derived infection(DDI)after kidney transplantation(KT).Methods:From January 1, 2015 to December 31, 2020, clinical data were retrospectively reviewed for 6 cases of vascular complications caused by DDI.Age, gender, surgical approaches, immunity induction therapy, immune suppression therapy, infection prevention, onset time of complication, type of complications, infection pathogens, therapeutic protocols and prognoses were summarized.Results:Six patients developed vascular complications caused by DDI in 997 KT recipients with an overall morbidity rate of 0.6%.In 3 cases, carbapenem resistant Klebsiella pneumoniae were positive in culture of secretion and blood samples.And Candida albicans was detected by blood cultures and pathological examinations.One case of antibiotic resistant Staphylococcus aureus was detected by blood culture.Among 3 cases of transplant kidney artery pseudoaneurysm on interventional therapy, there were curing(1 case)and immediate recurrent infection(2 cases). The latter two eventually died by cardiac complications.In 2 cases of arterial hemorrhage, graft nephrectomy was followed by hemodialysis.One case of transplanted renal artery stenosis was successfully cured by artery stenting and survived with normal graft function so far.Conclusions:Interventional endovascular therapy and open surgery are indicated for vascular complications caused by DDI post-KT.Interventional therapy may boost the odds of rescuing transplant kidney.However, clinicians should watch out for the risk of recurrent infection.Open surgery is an effective tool of eliminating infected focus.Preserving transplant kidney or nephrectomy may be adopted on the basis of specific conditions.

Caracterización de los pacientes revascularizados con pie diabético isquémico / Characterization of patients with revascularized ischemic diabetic foot

Introducción: El pie diabético se considera un problema de salud a escala mundial, debido al alto número de ingresos en los servicios hospitalarios. Objetivo: Caracterizar a los pacientes con pie diabético isquémico sometidos a cirugía revascularizadora en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se llevó a cabo un estudio descriptivo y retrospectivo en 24 pacientes que ingresaron en el Servicio de Angiopatía Diabética del Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de pie diabético isquémico, a los cuales se les realizó cualquier tipo de cirugía revascularizadora durante el período comprendido entre abril de 2018 y abril de 2019. Las variables estudiadas fueron: edad, sexo, factores de riesgo ateroscleróticos y enfermedades asociadas, patrón topográfico, clasificación de Fontaine, clasificación hemodinámica según la American College of Cardiology Foundation (ACCF) y técnicas quirúrgicas utilizadas. Se calcularon las frecuencias absolutas y relativas para las variables cualitativas. Resultados: Más del 95 por ciento de los pacientes eran mayores de 50 años. Hubo un predominó del sexo masculino (79,2 por ciento). La hipertensión arterial y el hábito de fumar resultaron los factores de riesgo de mayor frecuencia con igual porcentaje (79,8 por ciento). El patrón oclusivo predominante fue el fémoro-poplíteo (75 por ciento) y la técnica quirúrgica más utilizada resultó el bypass fémoro-poplíteo con prótesis sintética en la primera porción de la poplítea (54,1 por ciento). No se necesitó la amputación después de la cirugía en el 83 por ciento de los enfermos. Conclusiones: Los pacientes se caracterizaron por ser en su mayoría adultos mayores, fumadores e hipertensos. A estos se les realizaron, preferentemente, técnicas quirúrgicas convencionales sobre los procederes endovasculares(AU)

Introduction: Diabetic foot is considered a global health problem, due to the high number of hospital admissions. Objective: Characterize patients with ischemic diabetic foot undergoing revascularization surgery at the National Institute of Angiology and Vascular Surgery. Methods: A descriptive and retrospective study was carried out in 24 patients who were admitted in the Diabetic Angiopathy Service of the National Institute of Angiology and Vascular Surgery with the diagnosis of ischemic diabetic foot, whom underwent any kind of revascularization surgery during the period from April 2018 to April 2019. The variables studied were: age, sex, atherosclerotic risk factors and associated diseases, topographic pattern, Fontaine classification, hemodynamic classification according to the American College of Cardiology Foundation (ACCF) and surgical techniques used. Absolute and relative frequencies for qualitative variables were calculated. Results: More than 95 percent of patients were over 50 years of age. There was a predominance of the male sex (79.2 percent). High blood pressure and smoking habit resulted in the most common risk factors with the same percentage (79.8 percent). The predominant occlusive pattern was the femoro-popliteal (75 percent) and the most commonly used surgical technique was the femoro-popliteal bypass with synthetic prosthetics in the first portion of the popliteal (54.1 percent). No amputation was needed after surgery in 83 percent of patients. Conclusions: Patients were characterized by being mostly older adults, smokers and hypertensive ones. Preferably conventional surgical techniques on endovascular proceedings were performed to these patients(AU)

Expert consensus on perioperative vascular complications for liver transplantation(2021) / 临床肝胆病杂志

Vascular complications after liver transplantation are important causes of liver dysfunction and graft loss.The incidence rate range is from 5% to 25%, and the mortality rate is high. The complex and changeable vascular conditions of the donor and recipient, anastomosis techniques, infection, and acute and chronic rejection after transplantation can all cause vascular complications of liver transplantation. The types of vascular complications are diverse and complex. According to the vascular structure, they can be divided into arterial and venous complications; according to the characteristics of blood flow, they can be divided into inflow tract (hepatic artery, portal vein) or outflow tract (hepatic vein, vena cava) disorders; according to the nature of the lesion, they can be divided into rupture, stenosis, thrombosis and pseudoaneurysm, etc; according to the time of occurrence, they can be divided into early or late. Surgical plan design and surgical operation techniques are the technical factors of early vascular complications after liver transplantation. The types of vascular complications and their accompanying clinical manifestations are closely related to the choice of diagnosis and treatment strategies and clinical outcomes. Therefore, the Perioperative Management Group of Chinese Society of Organ Transplantation of Chinese Medical Association formulated the Expert Consensus on Diagnosis and Treatment of Perioperative Vascular Complications of Liver Transplantation, aiming to standardize and optimize the clinical diagnosis and treatment of common perioperative vascular complications in liver transplant recipients.

Real World Study to Evaluate Effect of SGLT2 Inhibitor Dapagliflozin on Markers of Macro and Micro Vascular Complications as add on Treatment in Type 2 Diabetes Patients

Introduction: In patients with type 2 diabetes mellitus,dapagliflozin, the sodium–glucose cotransporter 2 inhibitorhas been shown to improve diabetic control and reduceblood pressure. The main objective of the study is to evaluateefficacy of SGLT2 inhibitor dapagliflozin on markers of macroand micro vascular complications as add on treatment in type2 diabetes patients in real world set up.Material and methods: This was an observational studydone in real world set up. 87 patients were initially selectedamong whom 5 patients were lost in follow up and 2 patientswere excluded as they discontinued the study medicine. 80patients who received dapagliflozin 10 mg once daily for 24weeks in addition to metformin 1000 mg and glimepiride2 mg combination. Changes in both systolic and diastolicblood pressure, HbA1c (Glycated haemoglobin), fasting andpostprandial plasma glucose, lipid profile (including Totalcholesterol, Triglycerides, LDL and HDL cholesterol), serumcreatinine, serum microalbuminuria, eGFR and HOMA IRwere noted. All pathological test was executed at NABLaccredited lab.Results: After 24 weeks from baseline there was almost1.4% reduction in HbA1c. Fasting and post prandial bloodglucose was significantly reduced within 24 weeks. HOMAIR was significantly changed. No marked changes were seenin serum creatinine, microalbuminuria and eGFR. There wasa favorable reduction in lipid profile.Conclusion: Dapagliflozin has a very potent glycemic effectand has a significant impact on markers of macro and microvascular complications as add on treatment in type 2 diabetespatients. In conclusion it can be stated that early addition ofdapagliflozin therapy not only helps T2DM patients to achievetheir glycemic control but also prevents further macro andmicro vascular complications by reducing markers and riskfactors.

Is Serum Uric Acid an Added Risk Factor for Micro-Vascular Complications of Diabetes Mellitus? – A Prospective Study

Introduction: Diabetes is the leading cause of adult blindnessdue to retinopathy, end stage renal disease due to nephropathyand foot ulcers and lower limb amputation due to neuropathy.Serum uric acid levels independently predict the developmentof micro vascular complications. In this study, we analysethe association of serum uric acid with the micro vascularcomplications of diabetes.Material and methods: In this hospital based observationalstudy, hundred diabetic patients were included; of which fiftyhad micro vascular complications, the remaining fifty had nocomplications. Blood investigations including fasting(FBS)and post prandial blood sugars(PPBS), glycosylatedhaemoglobin (HbA1C), and serum creatinine and serumuric acid were done in all patients. All the parameters werecompared between the two groups.Results: Females presented with significantly highercomplications as compared to males. The mean age of thepatients presented with and without complications was 56.4± 9.3 and 59.9 ± 10.3 respectively. HbA1C had a positivecorrelation with the serum uric acid (SUA) (r=0.327, P =0.001). Mean uric acid levels were higher among patientswith complications (5.96 ± 2.16) compared to patients withoutcomplications (4.95 ± 2.04) which was statistically significant(P value =0.021). Patients with nephropathy and neuropathyhad significant elevation in serum uric acid levels than thosewithout; however this significance was not noted in those withretinopathy.Conclusion: Patients with micro vascular complications hadhigher levels of serum uric acid compared to those withoutcomplications. Also there was positive correlation betweenHbA1C and serum uric acid levels

Prevalence of cardiac autonomic neuropathy in type 2 diabetes mellitus and its correlation with other microvascular complications in South Indian population

Background: In individuals with type 2 diabetes mellitus (T2DM) the presence of Cardiac autonomic neuropathy (CAN) increases the risk of severe hypoglycaemia, cardiac arrhythmias, silent myocardial ischemia and stroke. It is also associated with increased perioperative morbidity and mortality, even with minor surgeries in these patients. The present study was conducted to assess the prevalence of CAN in T2DM patients and to investigate any possible association between CAN and micro vascular complications.Methods: 102 T2DM patients between the age of 30 years and 70 years, who attended outpatient department of Institute of Diabetology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, Tamil Nadu were included. All the selected patients underwent laboratory investigations, biothesiometry, fundus examination, and CAN assessment by CANS analyser.Results: A slight female preponderance was noted in the study, though it was statistically insignificant. Out of 102 patients, prevalence of CAN dysfunction was found in 82 (80.39%) of T2DM patients. No significant association of CAN was noted with duration of diabetes (p=0.772), HbA1c (p=0.827) and nephropathy (p=0.524). However, peripheral neuropathy (p=0.006) and retinopathy (p=0.03) were found to be significantly associated with CAN in T2DM patients.Conclusions: Prevalence of CAN in asymptomatic South Indian T2DM population was found to be 80.39%, with equal sex distribution and was most common in the 51- 60 years age group. Diabetic neuropathy and retinopathy were the most significant microvascular complications predictive of the incidence of CAN in T2DM patients.

Association of microvascular complications of type 2 diabetes mellitus with ABO blood group

Background: Micro vascular complications are the major outcome of Type 2 Diabetes Mellitus progression, which reduces the quality of life and increases diabetic morbidity & mortality. As the incidence of type 2 diabetes is growing day by day; our search for its aetiology and pathogenesis is also ever growing to predict its risk factors and early screening for better care and prevention of its complications. Many studies have tried to link susceptibility of type 2 diabetes with ABO blood group though results have been inconsistent. The present study aims to analyse association of micro vascular complication with different blood groups if any.Methods: A cross sectional study was conducted among patients of type 2 diabetes Mellitus in a tertiary care hospital. Determination of ABO and Rh status was done by standard slide method of agglutination. Detailed information about age, gender, BMI, duration of diabetes, age of onset of diabetes was noted with the help of a proforma. The records (clinical examination and investigations done by physician) were screened for type of micro vascular complications.Results: Out of a total of 319 patients suffering from type 2 diabetes, 209 subjects (65.15%) had one or the other complications. A statistically significant (p=0.00) difference was observed between the presence or absence of complications in different blood groups. In patients with Blood group B, 76.14% presented with complications. Though Nephropathy was the most common complication observed among different blood groups, none of the type of micro vascular complication was found to be significantly associated with different blood groups.Conclusions: The findings in our study suggest that although there was a significant association between presence or absence of complications and different blood groups, but this association was not significant for different types of complications.

A cross-sectional study on anemia in diabetic patients as a risk factor for development of diabetic retinopathy

Background: Anemia is a serious public health problem as harmful as the epidemic of infectious disease, especially in developing countries like India. With both the problems occurring together in an individual, the development of complications due to diabetes is severe and much earlier. Aim of the study: To estimate the prevalence of anemia in persons with type 2 diabetes mellitus and its role as a risk factor for the presence and the severity of diabetic retinopathy, in a population-based study. Materials and methods: This was a cross-sectional study conducted in about 200 diabetic inpatients in Government Royapettah Hospital, Chennai over a period of 6 months to study the correlation between low hemoglobin and development of diabetic retinopathy. Results: Fundus examination in anemic group showed normal interpretation in 49 patients, NPDR in 40 patients and 11 had PDR. In the non-anemic group, 68 patients had normal fundus examination, 26 had NPDR and 6 had PDR. The number of patients having diabetic retinopathy was greater in the anemic group than in the non-anemic group. Conclusion: Thus this study showed a positive correlation between anemia and earlier development of diabetic retinopathy. Hence, treatment of anemia must also be considered as a routine entity at the time of diagnosis of diabetes mellitus.

Correlation analysis of serum retinol binding protein 4 and serum Lipasin level with vascular complications in gestational diabetes mellitus / 中华内分泌外科杂志

Objective To explore the relationship between serum retinol binding protein 4 and serum Lipasin levels and vascular complications in gestational diabetes mellitus(GDM).Methods From Jan.2016 to Jan.2018,80 pregnant women with gestational diabetes diagnosed as GDM in Wenzhou Central Hospital of Zhejiang Province were selected as the study group.They were divided into two groups according to whether they had vascular lesions.Group A included patients with gestational diabetes mellitus complicated with vascular complications and group B included patients without vascular complications.Forty healthy pregnant women were selected as the control group(group C).The levels of fasting plasma glucose (FPG),fasting serum insulin (FINS),homeostatic model assessment of insulin resistance (HOMA-IR),serum retinol binding protein 4 (RBP4) and serum Lipasin were compared among three groups of pregnant women.The vascular complications of GDM were analyzed.Results The levels of FPG,FINS and HOMA-IR in gestational diabetes mellitus pregnant women were higher than those in healthy pregnant women (P＜0.05),and those in group A were higher than those in group B (P＜0.05).The levels of RBP4 and Lipasin in serum of pregnant women with GDM were higher than those of healthy pregnant women (P＜0.05),and those of group A were higher than those of group B (P＜0.05).Spearman univariate correlation analysis showed that serum RBP4 levels were positively correlated with FPG and FINS(P＜0.05),and serum Lipasin levels were positively correlated with FPG and FINS (P＜0.05).Logistic regression analysis showed that the levels of FPG,FINS,RBP4 and Lipasin increased,which were independent risk factors for diabetic retinopathy (P＜0.05).Conclusion In GDM with vascular complications,the serum RBP4 and Lipasin levels are higher,which are independent risk factors for vascular complications in GDM,and may participate in the occurrence and development of vascular complications in gestational diabetes mellitus.

Transradial versus transfemoral intervention in ST-segment elevation myocardial infarction patients in Korean population

BACKGROUND/AIMS: Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). METHODS: A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). RESULTS: After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. CONCLUSIONS: In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.

Outcomes of Liver Transplantation Using Pediatric Deceased Donor Livers: A Single-Center Analysis of 102 Donors / 中华医学杂志(英文版)

<p><b>Background</b>The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT.</p><p><b>Methods</b>A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications (VCs) were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients.</p><p><b>Results</b>There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016, 83 pediatric-to-pediatric LT (recipients' age ≤13 years) and 19 pediatric-to-adult LT (recipients' age ≥19 years). The ratio of early VC was similar in the two groups (19.3% vs. 10.6%, P = 0.514). Low body weight of recipient was an independent risk factor of early VC in pediatric LT (odds ratio: 0.856, 95% confidence interval: 0.752-0.975, P = 0.019). The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively (all P > 0.05). In all cases, patients using donors with hypernatremia (serum sodium levels ≥150 mmol/L) had worse graft survival (χ=4.330, P = 0.037).</p><p><b>Conclusions</b>Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.</p>

Virtual screening of anti-angiogenesis quinolizidine alkaloids from Leguminosae plant / 中草药

Objective: To investigate the mechanism of quinacridine alkaloids based on the systematic of screening compounds that play antitumor effect. Methods: The virtual screening technique was used and collected 103 quinolizidine alkaloids from Leguminosae plants, and selected eight targets, which were closely related to angiogenesis. The compounds were screened by using the LibDock module in Discovery Studio 2.5 (DS 2.5) software. In addition, the small-molecule approved drugs of targets from DrugBank database have scores, the minimum score of each target's approved drugs as threshold and the original ligand scoring were set as a reference. Results: Nineteen compounds were screened out, which scores were higher than the minimum score of approved drugs as well as being in the top of 10%, and the mechanism of quinolizidine alkaloids anti-angiogenesis was preliminarily revealed. Conclusion: The results suggest that the quinolizidine alkaloids may inhibit angiogenesis to play the role of antitumor, diabetic vascular complications and so on. Compared with traditional screening, virtual screening technology saves a lot of time, energy and resources, provided a new method for the development of angiogenesis inhibitor drugs.

Effect of Early Ambulation after Radiofrequency Catheter Ablation via Femoral Vein Approach / 中国康复理论与实践

Objective To investigate the effect of early ambulation on the comfort and complications in patients undergoing radiofre-quency catheter ablation via femoral vein approach. Methods From April,2016 to April,2017,120 patients were randomly assigned into control group(n=40),group A(n=40)and group B(n=40).The control group received the routine care of remaining bed rest for eight hours with the affected leg immobilized at least four hours.Group A ambulated after four hours of the affected leg immobili-zation,and group B changed their position after ablation and ambulated after four hours of bed rest.They were assessed with the General Comfort Questionnaire,Numerical Rating Scale of back pain and State Anxiety Inven-tory.Their vascular complications were recorded. Results The incidence of bleeding and hematoma was not significantly different among the groups(P>0.05).Group B was more comfortable than the control group(P<0.05).Compared with the control group,groups A and B were less in back pain intensity(F>10.376,P<0.001),and had less anxiety(t=3.278,P<0.05),less incidence of limb numbness, difficulty falling asleep, and loss of appetite and dysuria (χ2>6.409, P<0.05). Group B was the best among them. Conclusion There is little risk of early physical activity and ambulation in the vascular complications after radiofrequen-cy catheter ablation via femoral vein approach,which may reduce their discomfort.

Study of Anaemia in Type II Diabetes Mellitus in Relation to Glycemic Control

Background: Anaemia is not very uncommon in diabetics. Chronic hyperglycemia in uncontrolled diabetes is related to higher incidence of anaemia which goes unrecognized prior to the development of chronic renal failure. This study was conducted to know the prevalence of Anaemia in persons with Type II Diabetes Mellitus, in relation to glycemic control using HbA1c as a tool to it. Methods: 60 Diabetic subjects were divided into two groups of 30 each based on their glycemic control(group A, with poor glycemic control and group B with good glycemic control taking 7% Hba1c as cut off value),incidence of anaemia was measured and compared among them and also with 30 age and sex matched healthy non Diabetic controls. Results: Incidence of anaemia was found to be significantly higher in diabetics group as compared to non-diabetics and among diabetics it was significantly higher in uncontrolled group as compared to group with controlled diabetes. Conclusions: Anaemia is not an uncommon finding among Type II diabetics and further good glycemic control in diabetes is associated with a better haemoglobin levels, hence it is desirable to evaluate the haemoglobin level often to monitor for micro and macrovascular complications of diabetes even when the renal parameters are normal.