Diagnostic Efficacy of FNA-Tg in DTC Cervical LN Metastasis and its Impact Factors: A Large Retrospective Study.

CONTEXT: Thyroglobulin in needle washout fluid (FNA-Tg) has the advantage of compensating for the low sensitivity of cytological analysis (FNAC) in differentiated thyroid carcinoma (DTC) lymph node (LN) metastasis. However, studies of large data sets to support this view and identify the best cutoff of FNA-Tg are lacking. OBJECTIVE: Our study aimed to determine the best cutoff of FNA-Tg and explore the impact factors of FNA-Tg. METHOD: A total of 1106 suspicious LNs from patients treated at West China Hospital from October 2019 to August 2021 were included. Parameters were compared between metastatic and benign LNs, and the best cutoff value of FNA-Tg was identified by ROC curves. The impact factors of FNA-Tg were analyzed. RESULTS: In the nonsurgery group, after correcting for the effect of age and short diameter of LN, FNA-Tg was the independent risk factor for cervical LN metastasis of DTC (odds ratio [OR]: 1.048; 95% CI, 1.032-1.065). In the surgery group, after correcting for the effects of serum thyrotropin, serum Tg, long diameter of LN, and short diameter of LN, FNA-Tg was the independent risk factor for cervical LN metastasis of DTC (OR: 1.019; 95% CI, 1.006-1.033). The best cutoff value of FNA-Tg was 25.17 µg/L, and the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.944, 0.847, 0.978, 0.982, 0.819, and 0.902, respectively. FNA-Tg highly correlated with FNA-TgAb (P < .01; Spearman correlation coefficient = 0.559), but FNA-TgAb positivity did not undermine the diagnostic efficacy of FNA-Tg for DTC LN metastasis. CONCLUSION: The best cutoff value of FNA-Tg was 25.17 µg/L in diagnosing DTC cervical LN metastasis. FNA-Tg highly correlated with FNA-TgAb, but FNA-TgAb had no influence on the diagnostic efficacy of FNA-Tg.

A2DS2 Score Combined With Clinical and Neuroimaging Factors Better Predicts Stroke-Associated Pneumonia in Hyperacute Cerebral Infarction.

OBJECTIVE: To investigate the predictors of stroke-associated pneumonia (SAP) and poor functional outcome in patients with hyperacute cerebral infarction (HCI) by combining clinical factors, laboratory tests and neuroimaging features. METHODS: We included 205 patients with HCI from November 2018 to December 2019. The diagnostic criterion for SAP was occurrence within 7 days of the onset of stroke. Poor outcome was defined as a functional outcome based on a 3-months MRS score >3. The relationship of demographic, laboratory and neuroimaging variables with SAP and poor outcome was investigated using univariate and multivariate analyses. RESULTS: Fifty seven (27.8%) patients were diagnosed with SAP and 40 (19.5%) developed poor outcomes. A2DS2 score (OR = 1.284; 95% CI: 1.048-1.574; P = 0.016), previous stroke (OR = 2.630; 95% CI: 1.122-6.163; P = 0.026), consciousness (OR = 2.945; 95% CI: 1.514-5.729; P < 0.001), brain atrophy (OR = 1.427; 95% CI: 1.040-1.959; P = 0.028), and core infarct volume (OR = 1.715; 95% CI: 1.163-2.528; P = 0.006) were independently associated with the occurrence of SAP. Therefore, we combined these variables into a new SAP prediction model with the C-statistic of 0.84 (95% CI: 0.78-0.90). Fasting plasma glucose (OR = 1.404; 95% CI: 1.202-1.640; P < 0.001), NIHSS score (OR = 1.088; 95% CI: 1.010-1.172; P = 0.026), previous stroke (OR = 4.333; 95% CI: 1.645-11.418; P = 0.003), SAP (OR = 3.420; 95% CI: 1.332-8.787; P = 0.011), basal ganglia-dilated perivascular spaces (BG-dPVS) (OR = 2.124; 95% CI: 1.313-3.436; P = 0.002), and core infarct volume (OR = 1.680; 95% CI: 1.166-2.420; P = 0.005) were independently associated with poor outcome. The C-statistic of the outcome model was 0.87 (95% CI: 0.81-0.94). Furthermore, the SAP model significantly improved discrimination and net benefit more than the A2DS2 scale, with a C-statistic of 0.76 (95% CI: 0.69-0.83). CONCLUSIONS: After the addition of neuroimaging features, the models exhibit good differentiation and calibration for the prediction of the occurrence of SAP and the development of poor outcomes in HCI patients. The SAP model could better predict the SAP, representing a helpful and valid tool to obtain a net benefit compared with the A2DS2 scale.

Quantitative Ischemic Characteristics and Prognostic Analysis of Crossed Cerebellar Diaschisis in Hyperacute Ischemic Stroke.

OBJECTIVES: Crossed cerebellar diaschisis (CCD) is a secondary phenomenon caused by supratentorial brain injury, characterized by hypoperfusion and hypometabolism of the contralateral cerebellum. This study aimed to investigate the correlation between the quantitative data of initial supratentorial ischemia and CCD, and to further explore the prognosis value of CCD in the hyperacute phase. MATERIALS AND METHODS: The imaging and clinical data of 109 patients with hyperacute ischemic stroke were analyzed retrospectively, univariate analysis and multivariate logistic regression were used to observe the relationship between the volume and degree of initial supratentorial ischemia and CCD, respectively, and to further analyze the effects of CCD in the hyperacute phase on neurological function and clinical prognosis. RESULTS: The degree and volume of initial supratentorial ischemia was significantly correlated with hyperacute CCD. The volume of ischemic penumbra (OR=1.021 [95% CI: 1.009-1.033], P<0.001) and the reduction rate of cerebral blood volume (CBV) (OR=1.338 [95% CI: 1.073-1.668], P=0.01) were the main influencing factors of CCD; patients with hyperacute CCD had higher admission and discharge National Institutes of Health Stroke Scale (NIHSS) (P=0.046 and P=0.01), and more hemorrhagic transformation (P=0.021), but there was no significant difference in the final infarction volume (P=0.347) and the 90-day modified Rankin Scale (mRS) (P=0.757). CONCLUSION: Patients with CCD had larger initial supratentorial ischemic volume and more severe ischemic degree in the hyperacute ischemic stroke, more short-term neurological impairment, and worse short-term treatment effect, however, but the long-term functional prognosis was not be affected.

Diagnostic performance of the calcium/phosphate ratio for primary hyperparathyroidism in southwest China.

BACKGROUND: The diagnosis of primary hyperparathyroidism (PHPT) remains a challenge because of increased asymptomatic PHPT or patients with normocalcaemic PHPT (NPHPT). In addition, some primary hospitals in China have no equipment to measure parathyroid hormone (PTH) levels. Therefore, an additional, simple, and inexpensive laboratory biochemical marker is urgently needed. The calcium/phosphate (Ca/P) ratio and chloride/phosphate (Cl/P) ratio have been proposed as suitable tools to diagnose PHPT in Europe; however, the Ca/P ratio has never been tested in China. We aimed to conduct a confirmatory study to explore the diagnostic performance of the Ca/P ratio for PHPT in China. METHODS: From January 2015 to December 2020, a total of 155 patients who underwent parathyroidectomy (143 PHPT patients and 12 NPHPT patients) and 153 controls were enrolled in this single-center , retrospective study. Serum calcium, phosphate, parathyroid hormone, 25-hydroxyvitamin vitamin D (25(OH) vitamin D), chloride, alanine transaminase (ALT), aspartate aminotransaminase (AST), estimated glomerular filtration rate (eGFR), and creatinine levels were recorded for all the study participants. Pairwise comparisons were made between groups, and the diagnostic performance of the Ca/P ratio was determined using receiver-operating characteristic (ROC) analysis. RESULTS: Patients with PHPT had a higher Ca/P ratio than controls (P < 0.001). A Ca/P ratio above 2.94 with a sensitivity of 95.5% and specificity of 98.7% can distinguish PHPT patients from healthy individuals. This index was positively correlated with the PTH level (r = 0.875, P < 0.001). CONCLUSION: The Ca/P ratio is an ideal and inexpensive indicator for diagnosing PHPT in China when using a cut-off value of 2.94.

Association between functional polymorphisms in the flanking region of miR-143/145 and risk of papillary thyroid carcinoma: A case-control study.

MiR-143 and miR-145 were down-regulated in papillary thyroid carcinoma (PTC) involving in cell proliferation, apoptosis, migration, invasion, and epithelial to mesenchymal transition. In this study, we aimed to investigate the association between 2 functional polymorphisms (ie, rs4705342 and rs353292) in the flanking region of miR-143/145 and risk of PTC.A case-control study including 316 PTC patients and 347 controls was performed. The rs4705342 and rs353292 were genotyped by using the TaqMan allelic discrimination. The results were confirmed by DNA sequencing.For the rs4705342, a reduced risk of PTC was observed in heterozygous comparison, dominant genetic model and allele comparison (CC vs TT: adjusted OR = 0.37, 95% CI = 0.19-0.74, P = .003; CT/CC vs TT: adjusted OR = 0.64, 95% CI = 0.47-0.87, P = .005; C vs T: adjusted OR = 0.66, 95% CI = 0.52-0.85, P = .001, respectively). No significant difference was found in the genotypic distributions of the rs353292 between cases and controls.These findings indicate that the rs4705342 in the flanking region of miR-143/145 may be a protective factor against the occurrence of PTC. Further study is therefore required to investigate the correlation between the genotype and V-raf murine sarcoma viral oncogene homolog B1 V600E, rat sarcoma viral oncogene homolog mutations, rearranged in transformation/PTC1 and rearranged in transformation/PTC3.

Survivin is a prognostic marker and therapeutic target for extranodal, nasal-type natural killer/T cell lymphoma.

BACKGROUND: The relationship between survivin and extranodal, nasal-type natural killer/T cell lymphoma (ENKTCL) was unclearly established yet. We here studied the potential prognostic roles of survivin and its implication as a target in ENKTCL therapy. METHODS: ENKTCL patients' peripheral blood were collected and tested by ELISA. ENKTCL cell lines were cultured with or without survivin inhibitor and tested by MTT and Flow cytometry. According to the gene expression profiles from the ArrayExpress Archive under E-TABM-702, survivin co-regulated cluster was established by Coupled Two-way Clustering Algorithm. RESULTS: Seventeen point six percent of total 17 ENKTCL patients were serum survivin-positive. These patients had poorer outcome than that of negative cases (P<0.01). Analysis of survivin co-regulation genes in ENKTCL revealed that survivin was significantly involved in pluripotency, drug resistance, cell cycle and proliferation, indicating that it should be one of key regulators in ENKTCL and might be a latent therapeutic target. Our results just showed that YM155, a survivin inhibitor, had strong anti-tumor effect on ENKTCL cell lines in a dose dependent manner. It increased sub-G1 phase population and reduced G1- and G2-M phase populations (P<0.05). In addition, combining YM155 with DDP induced a larger decrease in cell viability than either agent alone and had a higher inhibition rate than Bliss index, suggesting their synergistic inhibition. CONCLUSIONS: We concluded that survivin was a potential prognostic marker and a critical regulatory molecule in the pathological process of ENKTCL. It would be a promising target in drugs discovery for ENKTCL therapy.

Study on the levels of glycosylated lipoprotein in patients with coronary artery atherosclerosis.

BACKGROUND: The main risk factors for atherosclerosis patients are not fully explicated. The aim of this study was to analyze the levels of blood lipid and glycosylated lipoprotein in patients with coronary artery atherosclerosis and healthy individuals and to study the relationship between the glycosylated lipoprotein and atherosclerosis. METHODS: The study involved 200 patients diagnosed with myocardial infarction caused by coronary atherosclerosis as case group and 230 healthy individuals as control group. We analyzed and contrasted the levels of blood lipid and glycosylated lipoprotein between the different groups. In addition, we investigated the correlation between glycosylated low-density lipoprotein (G-LDL) and glucose levels. RESULTS: There is no statistical difference between the level of TG in case group and control group. The level of CHOL, HDL-C, and LDL-C in case group is significantly lower than that in control group (3.90 [3.23, 4.42] vs 5.16 [4.86, 5.77] [mmol/L]; 1.09 [0.83, 1.38] vs 1.46 [1.15, 1.80] [mmol/L]; 2.22 [1.68, 2.81] vs 2.95 [2.60, 3.27] [mmol/L]) (P < 0.05). The level of GLU, HbA1c, G-HDL, and G-LDL in case group is significantly higher than that in control group (7.10 [5.68, 9.27] vs 4.84 [4.68, 5.07] [mmol/L]; 6.8 [6.3, 7.4] vs 5.9 [5.6, 6.1] [%]; 30.08 [25.04, 40.17] vs 22.95 [18.14, 27.06] [ng/mL], 6.26 [4.95, 7.50] vs 3.61 [2.66, 5.15] [ng/mL]) (p < 0.05). The level of G-LDL in patients with coronary atherosclerosis was relevant with the level of GLU and HbA1c (r = 0.625, 0.706, P < 0.05), and there was no relevance with LDL-C (r = 0.331, P > 0.05). CONCLUSION: Hyperlipidemia is not an important cause of coronary atherosclerosis. High glucose levels and glycosylated lipoprotein are of high importance in the development and progression of coronary atherosclerosis.

[Assessing Cardiac Function of Patients with Chronic Kidney Disease using N-Terminal Pro-brain Natriuretic Peptide Precursor (NT-proBNP)].

OBJECTIVE: To determine the plasma level of N-terminal brain natriuretic peptide precursor (NT-proBNP) in patients with chronic kidney disease (CKD) and its association with cardiac function. METHODS: A total of 567 CKD patients admitted to the hospital from January 2013 to December 2014 were divided into six groups according to their estimated glomerular filtration rate. Their plasma level of NT-proBNP, renal function, and cardiac function were determined. RESULTS: The worse patients cardiac function, and the lower eGFR, the higher concentration of plasma NT-proBNP. Plasma level of NT-proBNP was negatively correlated with glomerular filtration rate (=-0.529, P<0.01). The receiver operating characteristic curves generated a cutoff NT-proBNP value of 119.5 ng/L, 168.5 ng/L, 300.5 ng/L, 1 019.5 ng/L, 2 777.5 ng/L, and 3 640.5 ng/L, respectively, for diagnosing cardiac failure in the six groups, respectively. CONCLUSION: NT-proBNP is affected by renal function, which can be used for diagnosing cardiac failure in patients with CKD.

Prognostic impact of absolute lymphocyte count/absolute monocyte count ratio and prognostic score in patients with nasal-type, extranodal natural killer/T-cell lymphoma.

Nasal-type, extranodal natural killer/T-cell lymphoma is a heterogeneous disorder with poor prognosis, requiring risk stratification in this population. The combined value of baseline absolute lymphocyte count and absolute monocyte count provided prognostic information in some malignancies. However, the evidence requires validation in extranodal natural killer/T-cell lymphoma. Aiming to investigate the prognostic significance of absolute lymphocyte count/absolute monocyte count ratio and absolute lymphocyte count/absolute monocyte count prognostic score for extranodal natural killer/T-cell lymphoma, a retrospective research was carried out. A total of 264 patients with newly diagnosed extranodal natural killer/T-cell lymphoma were analyzed in this study. The patients' absolute lymphocyte count and absolute monocyte count tested at initial diagnosis were collected. Receiver operating curve analysis showed that the optimal cut-off values for absolute lymphocyte count and absolute monocyte count were 1.0 × 109 and 0.5 × 109L-1, respectively, and for absolute lymphocyte count/absolute monocyte count ratio was 2.85. After a median follow-up of 27 months (range 1-87 months), the 3-year overall survival and progression-free survival was 75.4% and 67.6%, respectively. Patients with absolute lymphocyte count/absolute monocyte count ratio ≥ 2.85 had better 3-year overall survival and progression-free survival than those with absolute lymphocyte count/absolute monocyte count ratio <2.85 (p < 0.001). According to absolute lymphocyte count/absolute monocyte count prognostic score, significant difference has been noticed in 3-year overall survival and progression-free survival (p < 0.001) and high absolute lymphocyte count/absolute monocyte count prognostic score was associated with poorer survival. The International Prognostic Index and Korean Prognostic Index were used for prognosis and showed no significant difference. When adding absolute lymphocyte count/absolute monocyte count ratio and absolute lymphocyte count/absolute monocyte count prognostic score to the International Prognostic Index and Korean Prognostic Index model, additional prognostic information was found. These results suggest that absolute lymphocyte count/absolute monocyte count ratio and absolute lymphocyte count/absolute monocyte count prognostic score might be useful prognostic factors in extranodal natural killer/T-cell lymphoma.

Diagnosis of Acute Myocardial Infarction in Hemodialysis Patients With High-Sensitivity Cardiac Troponin T Assay.

CONTEXT: Cardiac troponins have become the gold standard for diagnosing acute myocardial infarction (AMI) in the general population; however, their diagnostic accuracy for hemodialysis (HD) patients presenting with chest pain or dyspnea is uncertain. OBJECTIVE: To examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) assay for AMI in HD patients. DESIGN: In this prospective study, we enrolled 670 consecutive stable HD patients presenting with chest pain or dyspnea on routine predialysis therapy in the nephrology department. Receiver operating characteristic (ROC) curves were used to examine the diagnostic accuracy of hs-cTnT levels at enrollment in HD patients presenting with chest pain or dyspnea, and the dynamic change in these levels after 3 hours. RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 12% of HD patients. Among patients with a final diagnosis other than AMI, 97% had a plasma hs-cTnT concentration above the 99th percentile. At the time of enrollment, the area under the ROC curve of hs-cTnT levels for diagnosis of AMI was 0.68 (95% confidence interval [CI], 0.62-0.74; P < .001) with a cutoff value of 107.7 ng/L; the relative change after 3 hours was 0.90 (95% CI, 0.82-0.96, P < .001) with a cutoff value of 24%, and the absolute change was 0.88 (95% CI, 0.82-0.94, P < .001) with a cutoff value of 32.6 ng/L. The prognostic value for 40-day mortality varied with the magnitude of elevation in hs-cTnT levels. CONCLUSIONS: Tracking the dynamic change in hs-cTnT levels during the short term significantly increased this measure's diagnostic accuracy for AMI in HD patients.

[The Targeted Regulating Role of Has-miR-577 and Has-miR-583 on Gene FGF-21 Detected by the Dual Luciferase Reporter System.]

OBJECTIVES: To determine the targeted regulating role of has-miR-577 and has-miR-583 on the expression of fibroblast growth factor 21 (FGF-21) based on a constructed luciferase reporter FGF-21 gene vector. METHODS: The site of has-miR-577 and has-miR-583 target genes FGF-21 were predicted by the bioinformatics analyzing tools online.FGF-21 gene fragments,combined with has-miR-577 or has-miR-583 sequences and mutant sequences,were designed and synthesized.The wild type (psiCHECK2-FGF-21) and mutant (psiCHECK2-FGF-21-mut) luciferase reporter gene carriers were constructed.The relevant plasmids [hsa-miR-577mimics,hsa-miR-583 mimics or miR negative control (miR-NC)] and luciferase reporter gene carrier (wild type or mutant ) were co-transfected into 293T cells.The luciferase reporter system was used to detect the luciferase activity.The effects of has-miR-577 and has-miR-583 on the expression of FGF-21 were observed. RESULTS: The double enzyme electrophoresis and sequencing results showed that the gene fragment size and sequences of the wild type (psiCHECK2-FGF-21) and mutant (psiCHECK2-FGF-21-mut) carriers met expectations of the experiment.The luciferase assays revealed that has-miR-577 and has-miR-583 significantly diminished luciferase activity from the reporter vector containing 3'UTR of FGF-21 (P<0.05),whereas no suppression of luciferase activity was found in the mutant (psiCHECK2-FGF-21-mut). CONCLUSIONS: FGF-21 gene can be targeted by has-miR-577 and has-miR-583.

Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T.

BACKGROUND: The objective of this study was to examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for acute myocardial infarction (AMI) in patients with renal insufficiency, since this population has a high incidence of non-AMI elevations of hs-cTnT. METHODS: In this prospective study, we enrolled 2249 consecutive patients presenting with chest pain in the emergency department (ED), of whom 19.5% had an estimated glomerular filtration rate (eGFR)cys of <60 mL·min-1 (1.73 m2)-1. Hs-cTnT levels were measured blindly at presentation. RESULTS: Of the patients, 1108 (49.3%) were diagnosed as having AMI [321 with non-ST segment elevation myocardial infarction (NSTEMI)]. In patients whose final diagnosis was not AMI, there was a low but significant correlation between hs-cTnT and renal function [eGFRcys, r=-0.43 (-0.48, -0.38), p<0.001; eGFRcreat, r=-0.33 (-0.38, -0.27), p<0.001]. The area under the curve of the receiver operating characteristic (AUC) for hs-cTnT to diagnose AMI was 0.93 in patients with eGFRcys levels of <30 mL·min-1 (1.73 m2)-1, and AUCs did not vary significantly according to eGFR categories. On the basis of the ROC curve, the optimal threshold value for hs-cTnT was 143.6 ng·L-1 to diagnose AMI in patients with eGFRcys of <30 mL·min-1 (1.73 m2)-1, with a sensitivity of 83% and a specificity of 91%; 54.1 ng·L-1 in patients with eGFRcys between 30 and 59 mL·min-1, with a sensitivity of 90% and a specificity of 87%; 30.0 ng·L-1 in patients with eGFRcys between 60 and 89 mL·min-1, with a sensitivity of 89% and a specificity of 85%; and 20.3 ng·L-1 in patients with eGFRcys ≥90 mL·min-1 (1.73 m2)-1, with a sensitivity of 92% and a specificity of 88%. The same observations were done for the diagnosis of NSTEMI. CONCLUSIONS: Using a higher hs-cTnT cut-off value based on eGFR level is necessary for accurate diagnosis of AMI or NSTEMI in patients with renal insufficiency.

[Risk stratification of diabetic chronic kidney disease using eGFR equations].

OBJECTIVE: To compare different eGFR equations for risk stratification of diabetic chronic kidney disease. METHODS: A total of 601 diabetic patients participated in the study. Data about the patient serum cystatin C (Cys-C), blood urea nitrogen (BUN), creatinine (Scr), uric acid (UA), glycosylated hemoglobin (HbAlc), and urinary albumin creatinine ratio (ACR) were extracted. Simplified MDRD formula were used for calculating glomerular filtration rate (eGFR) using eGFR-EPlcrea, eGFR-EPIcys and eGFR-EPIcrea-cys. The patients were divided into three groups according to their urine ACR. Comparisons were made between the groups of patients in Cys-C, BUN, UA, eGFR and Scr. RESULTS: There were significant differences (P < 0.05) in Cys-C, eGFR-MDRD, eGFR EPIcrea, eGFR-EPIcys, and eGFR-EPIcrea-cys among the groups of patients. The different equations for risk stratification produced different distributions of patients among the three groups. Significant differences appeared among the groups in the distribution of patients using eGFR-MDRD (P < 0.05), eGFR-EPIcrea (P = 0.000) and eGFR-EPIcys (P < 0.05) and indication for stratification. No significant differences were found in the distribution of patient among the three groups (P > 0.05) using GFR-MDRD, eGFR-EPIcrea and eGFR-EPIcrea-cys as an indication for stratification. In low risk patients, eGFR-MDRD was higher than other eGFR (P < 0.05). In medium and high-risk patients, eGFR-MDRD and eGFR-EPIcrea were higher than eGFR-EPIcys and eGFR-EPIcrea-cys. In very high-risk patients, the four eGFR did not show differences. CONCLUSION: The performance of different eGFR equations differs in risk stratification of diabetic chronic kidney disease. In low-risk patients, MDRD equation may overestimate GFR level.

Dapagliflozin treatment for type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

CONTEXT: Type 2 diabetes has reached epidemic proportions and places a heavy burden on society. Dapagliflozin is a novel treatment choice for type 2 diabetes. OBJECTIVE: A meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of dapagliflozin treatment. DATA SOURCES: Medline (via PubMed), Embase (via OVID) and the Cochrane Library (up to August 2012) were searched, and RCTs were collected. STUDY SELECTION: Studies included type 2 diabetic subjects, who had been treated with dapagliflozin, and recorded HbA1c as outcomes. DATA EXTRACTION: Two reviewers independently assessed articles and study quality. Patient characteristics, interventions and outcomes were collected. DATA SYNTHESIS: Ten RCTs were included. Risk of bias for outcomes was low. Fixed or random effects models were used to pool the results. Dapagliflozin treatment was associated with a reduction in HbA1c [weighted mean difference (WMD): -0.53%; 95% confidence interval (CI): -0.58% to -0.47%; p < 0.00001], fasting plasma glucose (WMD: -1.06 mmol/L; 95% CI: -1.20, -0.92; p < 0.00001), and body weight (WMD: -1.63 kg; 95% CI: -1.83, -1.43; p < 0.00001). Dapagliflozin monotherapy did not lead to hypoglycaemia [relative risk (RR): 1.44; 95% CI: 0. 86, 2.41; p = 0.17], although hypoglycaemic risk increased (RR: 1.16; 95% CI: 1.05, 1.29; p = 0.005) when dapagliflozin was combined with other hypoglycaemic drugs. Dapagliflozin increased urinary glucose excretion (WMD: 26.98; 95% CI: 21.72, 32.24; p < 0.00001) and was associated with an increased risk of urinary tract infections (RR: 1.33; 95% CI: 1.10, 1.60; p = 0.004) and genital tract infections (RR: 3.23; 95% CI: 2.50, 4.18; p = 0.00001). CONCLUSIONS: Dapagliflozin appears to be an effective treatment for type 2 diabetes, although it may increase the risk of urinary tract infections and genital tract infections.

Procalcitonin levels predict acute kidney injury and prognosis in acute pancreatitis: a prospective study.

BACKGROUND: Acute kidney injury (AKI) has been proposed as a leading cause of mortality for acute pancreatitis (AP) patients admitted to the intensive care unit (ICU). This study investigated the predictive value of procalcitonin (PCT) for AKI development and relevant prognosis in patients with AP, and compared PCT's predictive power with that of other inflammation-related variables. METHODS: Between January 2011 and March 2013, we enrolled 305 cases with acute pancreatitis admitted to ICU. Serum levels of PCT, serum amyloid A (SAA), interleukin-6 (IL-6), and C reactive protein (CRP) were determined on admission. Serum PCT was tested in patients who developed AKI on the day of AKI occurrence and on either day 28 after occurrence (for survivors) or on the day of death (for those who died within 28 days). RESULTS: Serum PCT levels were 100-fold higher in the AKI group than in the non-AKI group on the day of ICU admission (p<0.05). The area under the receiver-operating characteristic (ROC) curve of PCT for predicting AKI was 0.986, which was superior to SAA, CRP, and IL-6 (p<0.05). ROC analysis revealed all variables tested had lower predictive performance for AKI prognosis. The average serum PCT level on day 28 (2.67 (0.89, 7.99) ng/ml) was significantly (p<0.0001) lower than on the day of AKI occurrence (43.71 (19.24,65.69) ng/ml) in survivors, but the serum PCT level on death (63.73 (34.22,94.30) ng/ml) was higher than on the day of AKI occurrence (37.55 (18.70,74.12) ng/ml) in non-survivors, although there was no significant difference between the two days in the latter group (p = 0.1365). CONCLUSION: Serum PCT is superior to CRP, IL-6, and SAA for predicting the development of AKI in patients with AP, and also can be used for dynamic evaluation of AKI prognosis.

Changes of plasma fibroblast growth factor-21 (FGF-21) in oral glucose tolerance test and effects of metformin on FGF-21 levels in type 2 diabetes mellitus.

INTRODUCTION: The objectives of our study were to investigate whether fibroblast growth factor-21 (FGF-21) is involved in short-term regulation of glucose and the change of FGF-21 after metformin use in diabetic subjects. MATERIAL AND METHODS: 43 subjects were recruited in the study, including 27 new-onset type 2 diabetes patients (nT2DM). A 75 g oral glucose tolerance test (OGTT) was administered to them. Blood samples were taken at 0, 60 ,120 and 180 minute of OGTT. nT2DM subjects were invited for further investigation, metformin was administered in a dose of 1.0 g every day for 1 week. RESULTS: Plasma FGF-21 changed significantly in the nT2DM group during the OGTT administration but not in the control group. No gender differences were observed at different time points in FGF-21 levels (p 〈 0.05). Administration of metformin for nT2DM resulted in a significant decrease in both glucose and FGF-21 at all OGTT times and in insulin at 60 min and 180 min, indicative of a decrease in HOMA-IR. CONCLUSION: FGF-21 does not seem to be involved in short-term regulation of glycaemia in human subjects, and the change in OGTT delayed in T2DM. FGF-21 may participate in the processing of metformin, improving glucose and insulin sensitivity.

Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection.

BACKGROUND: Procalcitonin (PCT) is an early, sensitive, and accurate marker for diagnosing infection and sepsis. As sepsis and septic shock are dominant causes of acute kidney injury (AKI), we investigated whether PCT is an early predictor of AKI in patients with symptoms of infection. METHODS: Between January 2011 and October 2011, 1361 inpatients in West China Hospital who displayed infection symptoms were enrolled in our study. Levels of PCT, serum amyloid A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell count (WBC) were determined and participants' renal function was monitored for 3 consecutive days. RESULTS: The rate of AKI occurrence 3 days after enrollment was 14.6%. Higher PCT levels were correlated with higher AKI occurrence rates and higher levels of serum urea, creatinine, and cystatin C (p<0.05). The area under the receiver-operating characteristic (ROC) curve (AUC) for PCT was 0.823, making it more predictive (p<0.0001) than SAA, CRP, IL-6, or WBC. The cut-off value of 1.575 ng/mL for PCT had the highest validity for predicting AKI in patients with infection symptoms. The sensitivity, specificity, negative-predictive value (NPV), positive-predictive value (PPV), negative-likelihood ratio (LR-), and positive-likelihood ratio (LR+) for this cut-off value were 61.7%, 84.6%, 93.6%, 37.5%, 0.415, and 4.98, respectively. CONCLUSIONS: PCT can be used as a predictive marker for sepsis-induced acute kidney injury in patients with symptoms of infection.

[The levels of serum cystatin C in patients with tumors and healthy controls].

OBJECTIVE: To determine the association between serum cystatin C and tumors. METHODS: Serum samples were obtained from 273 patients with tumors and 185 healthy volunteers. Serum cystatin C was determined by particle-enhanced turbidimetric immunoassay (PETIA). Student t-test, covariance analysis and multiple linear regressions were performed to examine the differences in the levels of cystatin C between the two groups. RESULTS: The student t-test did not show significant statistical differences in the serum cystatin C levels between the two groups (P = 0.075). However, such differences became statistically significant (P < 0.01) after adjustment of age. The multiple liner regression demonstrated that healthy volunteers and men had higher levels of cystatin C than those with tumors and women. Cystatin C also increased with age and decreases with estimating glomerular filtration rate. CONCLUSION: Cystatin C may be associated with the genesis and development of tumors.

Genetic variations in microRNA processing genes are associated with susceptibility in depression.

MicroRNAs (miRNAs) are new prominent gene expression regulators that have critical roles in neural development by regulating synaptic functions, and miRNA biogenesis may play an important role in psychiatric disorders. Despite emerging evidences demonstrating that single-nucleotide polymorphisms in the miRNA processing genes were associated with cancer and cardiovascular disorders, evidences about association between variants of the genes and depression are lacking. This study aims to find the association between miRNA processing gene variants and depression. We genotyped three polymorphisms from three miRNA processing genes in a case-control study including 314 patients and 252 matched healthy controls. The high-resolution melting method was used to genotype the three loci. Frequencies of genotypes and alleles showed significant difference between patients with depression and healthy controls in DGCR8 rs3757 and AGO1 rs636832. An allele frequency was significantly higher in rs3757 and lower in rs636832, respectively. Variant allele of DGCR8 rs3757 was associated with increased risk of suicidal tendency and improvement response to antidepressant treatment, whereas the variant of AGO1 rs636832 showed decreased risk of suicidal tendency, suicidal behavior, and recurrence. Besides allele frequency showed significant difference when compared patients with remission to controls, no significant differences were found in GEMIN4 rs7813 between patients and healthy controls. DGCR8 rs3757 and AGO1 rs636832 were found to have significant association with depression, and GEMIN4 rs7813 did not affect susceptibility to depression. These observations suggested that miRNA processing polymorphisms may affect depression risk and treatment.