Correlates of pericardial adipose tissue volume using multidetector CT scanning in cardiac patients in China.

BACKGROUND: Pericardial adipose tissue (PAT) is an emerging cardiovascular risk factor, yet much less is understood about PAT volume in Chinese adults, especially in relation to physical activity. The study explores associations between demographic and clinical variables and PAT volume, using multidetector computed tomography (MDCT) scanning in China. We also examined the relationship between PAT volume and coronary artery disease (CAD). METHODS: An observational, correlational study design was used. Chinese (n=163) attended a study visit and underwent MDCT scanning between September 2014 and December 2015. RESULTS: Participants were 48.5% male and had a mean age of 60.6 (SD 9.4) years. PAT volume was higher (p=0.001) in males than in females. PAT volume was correlated with age (r=0.388, p=0.001), systolic blood pressure (r=0.205, p=0.009), body mass index (r=0.466, p=0.001), high-density cholesterol (r=-0.282, p=0.001), low-density cholesterol (r=0.177, p=0.024), and triglycerides (r=0.248, p=0.001). Both moderate intensity physical activity energy consumption (r=-0.363, p=0.001) and total physical activity (r=-0.290, p=0.001) had inverse relationships with PAT volume. Total sedentary energy consumption was positively related to PAT volume (r=0.266, p=0.001). Multiple regression revealed that age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume (R2=0.465). The relationship between PAT volume and CAD was found to be significant in the adjusted models. CONCLUSIONS: Age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume, and PAT volume itself is a predictor of CAD.

Effect of Gua sha therapy on perimenopausal syndrome: a randomized controlled trial.

OBJECTIVE: This study aims to evaluate the effectiveness and safety of Gua sha therapy on perimenopausal symptoms, quality of life, and serum female hormones in participants with perimenopausal syndrome. METHODS: A prospective, randomized, controlled clinical trial was conducted at the First Affiliated Hospital of Nanjing University of Chinese Medicine in China. Eighty women with perimenopausal syndrome were recruited and randomized into an intervention group or a control group. Participants in the intervention group received 15-minute Gua sha treatment sessions once a week plus conventional treatment for 8 weeks, whereas participants in the control group received conventional treatment alone. The primary outcome was the change in perimenopausal symptoms and quality of life as obtained through the modified Kupperman Index (KI) and the Menopause-Specific Quality of Life. The secondary outcome was the change of serum female hormones including estrogen, follicle-stimulating hormone, and luteinizing hormone. RESULTS: Seventy-five out of 80 participants (93.8%) completed the study-38 in the intervention group and 37 in the control group. The baseline levels of demographic and outcome measurements were comparable between the two groups. After eight sessions of intervention, the reduction in the total modified KI score was, however, 16.32 ±â€Š4.38 in the intervention group and 11.46 ±â€Š5.96 in the control group, with a difference of 4.86 ±â€Š6.15 (P < 0.01) between the two groups. Also the reductions of hot flash/sweating, paresthesia, insomnia, nervousness, melancholia, fatigue, and headache were greater in the intervention group than in the control group (P < 0.05). The reduction in the total Menopause-Specific Quality of Life score was 17.87 ±â€Š3.84 in the intervention group and 13.62 ±â€Š7.40 in the control group, with a difference of 4.46 ±â€Š7.52 (P < 0.01) between the two groups. And the scores for vasomotor, psychosocial, and physical domains in the intervention group were significantly lower than those in the control group (P < 0.05). There were no significant differences in serum estrogen, follicle-stimulating hormone, and luteinizing hormone between the two groups. CONCLUSIONS: The results of this study suggest that Gua sha therapy was effective and safe in relieving perimenopausal symptoms and improving the quality of life in participants with perimenopausal syndrome. The therapy may serve as a promising, effective, nondrug treatment for perimenopausal syndrome in clinical work. Additional research is needed to better understand its effectiveness and examine its mechanism for treating perimenopausal syndrome.

Investigation into knowledge, attitude, and practice regarding medical nutrition therapy among patients with diabetes in China: Results from a national multicenter cross-sectional study.

BACKGROUND: The aim of the present study was to investigate knowledge, attitude, and practice (KAP) associated with medical nutrition therapy (MNT) among Chinese adult patients with diabetes and prediabetes. METHODS: From May to August 2014, a cross-sectional study was conducted in 40 hospitals across China. The KAP of respondents was investigated through a pretested structured questionnaire in face-to-face interviews. Anthropometric and biochemical data were collected, and KAP scores were recorded according to patient responses. RESULTS: In all, responses from 7017 of 7508 patients were analyzed. The mean (±SD) overall KAP score was 9.63 ± 3.46, with individual scores for the K, A, and P components being 2.69 ± 1.90, 1.77 ± 1.99, and 5.17 ± 1.99, respectively (out of possible total scores of 19, 6, 3, and 10, respectively). All scores were higher in respondents who received ≥15 min MNT education than in those with shorter sessions. Patients with higher KAP scores exhibited significantly better glycemic control, with a higher proportion achieving target HbA1c, fasting plasma glucose, and 2-h postprandial blood glucose levels (P < 0.05). "Health publicity in hospitals" and "expert outpatient services" were the most favorable means of acquiring MNT information. The two predominant concerns associated with MNT were "the feasibility" and "the authenticity and professionalism of the information". CONCLUSIONS: Patients with diabetes and prediabetes achieved moderate scores for KAP towards MNT. Glycemic control was positively correlated with the KAP score. Thus, MNT education should be improved, with a particular focus on feasibility and authenticity and professionalism, in China.

A systematic review of the identification of seniors at risk (ISAR) tool for the prediction of adverse outcome in elderly patients seen in the emergency department.

The purpose of this systematic review was to evaluate the predictive validity of the Identification of Seniors at Risk (ISAR) Tool in identifying elderly patients at risk of adverse outcomes after a visit to the emergency department (ED). Since older adults are frequently sent to the ED, screening for risk of adverse outcomes in elderly patients is increasingly important in the ED. Also it is a way to ensure that interventions based on a comprehensive geriatric assessment (CGA) are provided to patients identified at risk to reduce the risk of adverse outcomes. The ISAR is a six-item risk-screening tool for elderly patients seen in the ED. However the predictive validity of ISAR is controversial. Relevant studies from January 1999 through December 2014 were searched systematically in PubMed, Cochrane Library, Web of Knowledge, Scopus, CINAHL, Elsevier ScienceDirect databases. The language was restricted to English. This review was based on the recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews. Ten studies (8680 patients) were included in this review. With a cutoff score at least 2, the ISAR was proved to have poor validity related to revisiting the ED (AUC: 0.59-0.60) and hospital readmission (AUC: 0.59-0.60). The predictive validity of the ISAR related to mortality and composite outcomes was graded as poor to fair. It is not suitable to use the ISAR alone for identifying seniors at risk for adverse outcomes in the ED.

Efficacy of structured education in patients with type 2 diabetes mellitus receiving insulin treatment.

BACKGROUND: The aim of the present study was to assess the efficacy of structured education in insulin-treated type 2 diabetes mellitus (T2DM) patients. METHODS: In a 16-week open-label randomized controlled study, 1511 T2DM patients with inadequate responses to two or more oral antidiabetic drugs (OADs) for >3 months (HbA1c >7.5%) were randomized (1:1) to either an education group (structured diabetes education plus insulin therapy) or a control group (usual care plus insulin therapy). Both groups discontinued previous OADs (except biguanides and α-glucosidase inhibitors) and started twice daily injections of 30% soluble-70% isophane recombinant insulin. The primary endpoint was the change in HbA1c from baseline. Efficacy and safety data were analyzed for within- and between-group differences. RESULTS: Of the initial 1511 patients, 1289 completed the study (643 in the control group; 646 in the education group). At the end of the study, significant reductions in HbA1c versus baseline were evident in both groups, but the reduction was greater in the education group (2.16% vs. 2.08%; P < 0.05). A higher proportion of patients in the education group achieved target HbA1c levels <7% (43.81% vs. 36.86%; P < 0.05) and ≤6.5% (28.48% vs. 22.71%; P < 0.05). In addition, patients in the education group showed greater increments in scores and improvement in the Morisky Medication Adherence Scale (P < 0.05). The overall incidence of hypoglycemic events was similar in the two groups. CONCLUSIONS: Structured education can promote the ability of patients to self-manage and their compliance with medications, thereby achieving better outcomes.

A nationwide survey of diabetes education, self-management and glycemic control in patients with type 2 diabetes in China.

BACKGROUND: Diabetes management could be improved by diabetes education, through influencing attitudes towards diabetes, knowledge and behaviors of patients. The purpose of this study was to characterize the impact of diabetes education on glycemic control, and to assess the attitude, knowledge and self-care behavior in patients with type 2 diabetes in China. METHODS: This questionnaire-based survey was conducted in 50 medical centers across China from April to July of 2010. The patients with type 2 diabetes were eligible for the study. The information of glycemic control and diabetes education was collected. The diabetes attitude scale-3 formulae, a questionnaire of diabetes knowledge and Summary of Diabetes Self-care Activities scale were used to assess attitude, knowledge and the self-care of patients, respectively. RESULTS: Among the 5961 eligible respondents (3233 males; mean age (59.50 ± 12.48) years; mean hemoglobin A1c (HbA1c) (8.27 ± 2.23)%), most patients (79.8%) considered themselves educated on diabetes. Compared with patients without diabetes education, their educated counterparts showed significant lower value of HbA1c, after controlling for age, gender, body mass index and duration of diabetes (P < 0.01). The patients who received diabetes education also performed significant higher scores on attitude, knowledge and self-care than their uneducated counterparts. Patients with lower income or education level tended to have higher glucose levels, and showed lower percentage of patients received diabetic education. CONCLUSIONS: Chinese patients with diabetes education achieved better glycemic control than un-educated patients. Our study indicates effort is required to provide professional education to patients, with emphasis on lower income and lower education level populations.

Study on female sexual dysfunction in type 2 diabetic Chinese women.

OBJECTIVE: To investigate the female sexual dysfunction (FSD) in type 2 diabetes patients, by comparing the sexual function between type 2 diabetic women and non-diabetic women with Female Sexual Function Index (FSFI). METHODS: 115 type 2 diabetic women and 107 age-matched non-diabetes women were enrolled with similar backgrounds. Their sexual functions were evaluated with FSFI. Metabolic parameters such as body mass index, blood lipid profile, hemoglobin A1C, plasma glucose were also collected. RESULTS: Total score of FSFI of the type 2 diabetic women were significantly lower than that of the non-diabetic controls (18.27±8.96 vs. 23.02±5.78, P=0.000). Scores of the FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, pain) of the type 2 diabetic group were also lower than those of the control group. According to the FSD criterion (FSFI<25) available in China, the percentage of FSD in the type 2 diabetic group was significantly higher than that of the control group (79.2%vs. 55.0%, P<0.001). These trends seemed more prominent in pre-menopause subgroups. The logistic regression analysis indicated that age and diabetes were independent risk factors of FSD. Body Mass Index (BMI) also had influence in the diabetes group. CONCLUSION: Findings from this study showed that there are more FDS in Chinese type 2 diabetic women than in their non-diabetic counterparts, especially in pre-menopause participants.