Clinical Application of Metformin Use in Anhui Province, China: A Cross-Sectional Study.

Purpose: Given the importance of metformin, reasonable utilization is essential. We designed a cross-sectional survey on physicians' attitude and clinical application of metformin in Anhui Province, China. Methods: The survey was distributed via an electronic questionnaire among endocrinologists and general practitioners. Seven representative questions were used to evaluate professional levels. Results: Among the 477 valid responses, 72.75% of the respondents preferred to prescribe metformin extended-release, while only 34.38% of them would prescribe metformin extended-release at the correct frequency. More than half of the respondents thought that estimated glomerular filtration rate ˂ 45 mL/min/1.73 m² should be the contraindication of metformin prescription. Less than 10% of the physicians selected correct responses for two questions regarding metformin usage and contrast agent. Physicians with higher levels of hospital grades, education background and professional titles as well as working in general hospitals and in the Department of Endocrinology achieved high scores (P˂0.05). Logistic regression showed that department was an independent predictor for high scores. Conclusion: Physicians, especially non-endocrinologists, are not at a professional level for prescribing metformin. Physicians should be highly vigilant in terms of standardized prescription for metformin. The guidelines or consensuses about diabetes care for physicians should be promoted.

The association between thyroid dysfunction (TD) and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM).

BACKGROUND: Epidemiological studies have identified an association between thyroid dysfunction (TD) and various kidney diseases. In this study, the prevalence of TD in type 2 diabetic mellitus (T2DM) patients with diabetic kidney disease (DKD) was evaluated to analyse the potential association between TD and DKD in T2DM patients. METHODOLOGY: A total of 2108 T2DM patients from Anhui Provincial Hospital were recruited in this study. Demographic and clinical characteristics were collected from 834 T2DM patients with DKD and 1274 T2DM patients without DKD (non-DKD). All patients were stratified into a number of groups based on UACR (urine albumin-to-creatinine ratio) or eGFR (estimated glomerular filtration rate): (a) A1: normoalbuminuria (<30), A2: microalbuminuria (30-300) and A3: macroalbuminuria (>300); (b) F1: normal filtration (60-139), F2: hyper filtration (≥140) and F3: low filtration (<60). RESULTS: Significant differences were observed between the non-DKD and DKD groups (P < .05) in age, sex ratio, duration, systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, serum creatinine, blood urea nitrogen, free triiodothyronine (FT3), free thyroxine (FT4) and sensitive thyrotropin hormone (sTSH). The macroalbuminuira and low filtration groups had the lowest levels of FT3 and FT4 and the highest level of sTSH, compared with all other groups (P < .0167). The prevalence of subclinical hypothyroidism in the DKD group was significantly higher than that in the non-DKD group (χ2  = 13.92, P < .01). Logistic regression analysis showed that hypothyroidism was associated with increased UACR or reduced eGFR in T2DM patients. Compared with controls, T2DM patients with hypothyroidism exhibited a higher UACR and urinary excretion of transferrin, as well as a lower excretion of urinary Tamm-Horsfall protein (THP) (P < .0167). CONCLUSION: Subclinical hypothyroidism is more prevalent in T2DM patients with DKD than in T2DM patients without DKD. Hypothyroidism is associated with albuminuria and decreased eGFR in T2DM patients.

A study of urinary Tamm-Horsfall protein excretion in adult type 2 diabetes mellitus
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AIM: To study the excretion of urinary Tamm-Horsfall protein (THP) with a wide range of urinary albumin creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) in a population with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A retrospective investigation was performed in 3,599 adult inpatients with T2DM in Anhui Provincial Hospital of China. Demographic information, urinary THP data, and other lab reports were obtained from the Electronic Patient Record (EPR). RESULTS: (1) In T2DM, average HbA1c was 8.6%, and 55.2% of the patients had an HbA1c > 9%. The percentages with normal excretion, decreased excretion, and increased excretion of urinary THP were 49.8%, 41.7%, and 8.5%, respectively. Serum creatinine (Scr), blood urea nitrogen (BUN), and UACR levels were highest, and eGFR was lowest, in the decreased urinary THP group. (2) The proportion of decreased urinary THP excretion rose, and the level of urinary THP declined when UACR increased or eGFR decreased. (3) Urinary THP showed a negative correlation to Scr, BUN, triglyceride (TG), and UACR (rs = -0.173, -0.228, -0.060 and -0.237, respectively), but a positive correlation with eGFR and high-density lipoprotein cholesterol (HDL-C) (rs =0.128 and 0.040, respectively). (4) Logistical regression analysis showed that Scr, BUN, TG, UACR, and eGFR were independent risk factors for decreased urinary THP (OR = 3.477, 1.461, 1.160, 2.124, and 2.087, respectively). CONCLUSION: Increased albuminuria and decreased GFR are predictors of decreased urinary THP excretion. Distal convoluted tubule lesion may precede glomerular damage in a portion of T2DM patients.
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Cytotoxic effect of a combination of bluetongue virus and radiation on prostate cancer.

This study aimed to investigate the lethal effect of the combination of bluetongue virus (BTV) and radiation on RM-1 murine prostate cancer cells in vitro and in vivo. Various cell lines were infected with BTV and the cytotoxicity was tested by a lactate dehydrogenase (LDH) release bioassay. Additionally, the RM-1 cells were treated with radiation and/or BTV to assess cell viability using the Cell Counting Kit-8 method. The levels of apoptosis of the RM-1 cells were detected by fluorescence-activated cell sorting (FACS). To identify a possible mechanism for the radiation-induced change in the oncolytic activity of BTV, cell cycle analyses were performed. The effects of different schedules of BTV and radiotherapy on cytotoxicity were assessed in vitro and the combined effect was also assessed in tumor models in vivo. The results demonstrated that BTV had a selective cytotoxic effect on RM-1 and PC-3 cancer cells, but did not affect normal cells, specifically, human umbilical vein endothelial cells and smooth muscle cells. The combination of BTV and radiation enhanced the cytotoxicity compared with that of each agent alone and had a synergistic effect in vitro and in vivo. The results of the FACS confirmed that radiotherapy induced apoptosis, as did BTV alone, and the combination treatment generated the most prominent levels of apoptosis, which were the highest in the early stage. The analysis of the cell cycle indicated that the G2-M phase levels increased after irradiation followed by infection with BTV. In conclusion, the combination of BTV and radiotherapy had an enhanced cytotoxic effect on RM-1 cells in vitro and in vivo compared with that of either treatment alone, and demonstrated a synergistic efficacy, in addition to a marked apoptosis-inducing effect. These results support the future investigation of BTV for potential clinical use in patients with prostate cancer.

Association between soy isoflavone intake and breast cancer risk for pre- and post-menopausal women: a meta-analysis of epidemiological studies.

BACKGROUND: Conclusions drawn from meta-analyses on the association between soy isoflavone intake and breast cancer risk for pre- and post-menopausal women are not fully consistent. These meta-analyses did not explore the influence of different study designs on the pooled results on the basis of distinguishing between pre- and post-menopausal women. METHODOLOGY AND PRINCIPAL FINDINGS: We performed a meta-analysis of 35 studies which reported results of association between soy isoflavone intake and breast cancer risk for pre- and/or post-menopausal women, calculated pooled odds ratios and their 95% confidence intervals of pre- and post-menopausal women respectively, and further explored soy isoflavone-breast cancer association on the basis of considering different study regions and designs. Summary results suggested that soy isoflavone intake has a protective effect against breast cancer for both pre- and post-menopausal women. However, they are influenced by study design and region. Pooled ORs of studies carried out in Asian countries suggested that soy isoflavone's protective effect exist in both pre- and post-menopausal women (OR = 0.59, 95%CI: 0.48-0.69 for premenopausal women; OR = 0.59, 95%CI: 0.44-0.74 for postmenopausal women). However, there are some differences between the results pooled from different study designs for women in Asian countries (test for consistency, P = 0.04). Pooled OR of studies on postmenopausal women in Western countries suggested that soy isoflavone intake has a marginally significant protective effect (OR = 0.92; 95%CI: 0.83 ∼ 1.00), but further analyses stratifying by study design found no statistically significant association. CONCLUSIONS: We meta-analyzed more and newer research results, and separated women according to menopausal status to explore soy isoflavone-breast cancer association. We founded that soy isoflavone intake could lower the risk of breast cancer for both pre- and post-menopausal women in Asian countries. However, for women in Western countries, pre- or post-menopausal, there is no evidence to suggest an association between intake of soy isoflavone and breast cancer.