Glycemic control and comprehensive metabolic risk factors control in older adults with type 2 diabetes.

BACKGROUND: Older adults with type 2 diabetes are prone to multiple metabolic abnormalities. However, data from these patients on comprehensive metabolic risk factors control are limited. METHODS: The present study included 2736 older adults aged 60 to 90 years with type 2 diabetes from 114 hospitals across 22 provinces in China. Metabolic abnormalities, including hypertension, dyslipidemia, hyperuricemia, and obesity, were recorded. Comprehensive metabolic risk factors control included the control of hemoglobin A1c (HbA1c) level, blood pressure, serum lipids level, serum uric acid level, and body mass index. The target glycemic control was defined as HbA1c <7%. RESULTS: The proportion of older adults who achieved the HbA1c target was 23.0%. The glycemic control rate increased with the number of metabolic abnormalities increased. The patients who had all four metabolic abnormalities had 4.05 times (95% confidence interval: 2.16, 7.61) the odd to meet glycemic target than those with none of metabolic abnormalities. However, only 4.6% of patients met the targets for all 5 metabolic risk factors. The comprehensive rate of all 5 factors in control decreased from 13.4% to 0% with the number of metabolic abnormalities increased. CONCLUSION: The glycemic control rate and the comprehensive metabolic risk factors control rate were 23.0% and 4.6%, respectively. As the number of metabolic abnormalities increased, the number of risk factor targets achieved decreased. Our findings suggest that a strategy for comprehensive control is urgently needed in older adults with type 2 diabetes, especially in those with co-existing metabolic abnormalities.

Association between plasma essential amino acids and atherogenic lipid profile in a Chinese population: A cross-sectional study.

BACKGROUND AND AIMS: The association between amino acids and small dense low-density lipoprotein cholesterol (sdLDL-C) and remnant-like particle cholesterol (RLP-C) remains poorly understood. This study aims to investigate the association between plasma essential amino acids (EAAs) and atherogenic lipid profiles. METHODS: Plasma amino acid levels of 475 individuals were measured using liquid chromatography-mass spectrometry. SdLDL-C, RLP-C, and other lipid components were evaluated. Associations between EAAs and lipid components or dyslipidemia were determined using correlation analysis and multivariate logistic regression. RESULTS: Concentrations of plasma branched-chain amino acid (BCAA) were positively correlated with sdLDL-C, RLP-C, and triglycerides (TG) levels, but inversely correlated with high-density lipoprotein cholesterol (HDL-C). In contrast, threonine concentration was inversely correlated with sdLDL-C, RLP-C, and TG. Compared with the lowest tertile, individuals in the highest tertile of plasma total BCAAs level had an odds ratio (OR) of 2.33 (95% confidence interval [CI]: 1.35, 4.03) for the risk of high sdLDL-C, 3.63 (95%CI: 1.69, 7.80) for the risk of high RLP-C, 3.10 (95%CI: 1.66, 5.80) for the risk of high TG, and 3.67 (95%CI: 2.00, 6.73) for atherogenic lipid triad (all p < 0.01). In contrast, compared with the lowest tertile, individuals in the highest plasma threonine tertile had a 43% lower OR for high sdLDL-C, 56% lower OR for high TG, and 55% lower OR for lipid triad risk (all p < 0.05). CONCLUSIONS: Among the EAAs evaluated, elevated plasma BCAAs were significantly associated with increased risk of atherogenic lipid profile. In contrast, elevated threonine was associated with reduced risk of atherogenic lipid profile.

The impact of insulin pump therapy to oxidative stress in patients with diabetic nephropathy.

BACKGROUND: The oxidative stress resulting from increased production of ROS plays a crucial role in the development of diabetic complications. We aim to explore the relationships between oxidative stress, diabetic nephropathy (DN) and short-term insulin pump intensive therapy (insulin therapy). METHODS: Levels of 8-hydroxy-deoxyguanosine (8-OHdG), 3-nitrotyrosine (3-NT), glutathione (GSH), superoxide dismutase (SOD) and Interleukin-6 (IL-6) were estimated before and after 2 weeks of insulin therapy in normal group (NC) and type 2 diabetic (DM) with normal albuminuria (NA), microalbuminuria (MA) and clinical albuminuria (CA). RESULTS: In DM group, levels of 8-OHdG and 3-NT were higher than those in NC group (P < 0.05); GSH and SOD were lower (P < 0.05). And their levels changed with urine albumin-creatinine ratio (P < 0.05). After insulin therapy, these derangements were significantly ameliorated and the changes in NA and MA groups were more significant than CA group (P < 0.05). Correlation analysis showed glycated hemoglobin, the course of disease, the HOME-IR and fasting plasma glucose were positively correlated with 8-OHdG and 3-NT, but negatively correlated with GSH and SOD. CONCLUSIONS: The oxidative stress gradually increased with the magnitude of DN, and insulin pump intensive therapy can significantly ameliorate the derangements in the early stage of DN. Trial registration NCT03174821.

Factors related to the use of reperfusion strategies in elderly patients with acute myocardial infarction.

BACKGROUND: About eighty percent of acute myocardial infarction (AMI) cases occur in the elderly, we aim to examine the use of reperfusion strategies in elderly patients (≥65 years) with AMI and to investigate the factors affecting the use of these strategies. METHODS: A total of 352 consecutive elderly patients (≥65 years) with ST-elevated AMI (STAMI) were admitted, they were divided into 2 groups based on reperfusion treatment (thrombolysis or percutaneous coronary intervention, PCI): reperfusion therapy group (n = 268) and non-reperfusion therapy group (n = 84). Demographic and medical data were collected for comparison. Odds ratios (OR) and 95% confidence interval (C.I.) were calculated directly from the estimated regression coefficients. RESULTS: About 76.1% of the elderly patients with AMI received reperfusion treatment (62.5% received PCI, and 13.6% received thrombolysis). Stepwise Logistic regression analysis revealed that a patient age ≥75 years (95% CI: 0.194 ~ 0.590, OR = 0.338, P = 0.000) and medical history of angina (95% CI: 0.281 ~ 0.928, OR = 0.501, P = 0.014) were determining factors for receiving less reperfusion therapy. Complications including right ventricular myocardial infarction (MI) (95% CI: 1.618 ~ 12.907, OR = 4.472, P = 0.003), unbearable symptoms (95% CI: 1.132 ~ 3.928, OR = 1.839, P = 0.021) and medical insurance (95% CI: 1.313 ~ 4.524, OR = 2.429, P = 0.004) were independent predictors of reperfusion therapy. The reperfusion therapy subset analysis revealed that intracranial hemorrhage (2.7% vs. 8.3%, P = 0.000), left ventricular ejection fraction (LVEF) <45% (13.2% vs. 29.2%, P = 0.019) and mortality rate within 1 year (2.7% vs. 6.3%, P = 0.045) were significantly decreased in the PCI group as compared with thrombolysis. CONCLUSION: Elderly patients with a medical history of angina, right ventricular MI, unbearable symptoms and medical insurance are likely be recipients of reperfusion strategies.

Neuroprotective effect of AG490 in experimental traumatic brain injury of rats.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability in children and young adults worldwide. Therefore, we investigated the role of AG490 in regulating brain oedema, expression of CD40 and neurological function after TBI. METHODS: Sprague Dawley rats (n = 240) were randomly divided into a sham operation group, TBI+saline group and TBI+AG490 (JAK/STAT inhibitor) group. Members of each group were euthanized at 6, 12, 24 or 72 hours after injury. Neurological severity score (NSS) was used to evaluate the severity of neurological damage. Brain water was quantitated by wet/dry weight method. The expression of CD40 was assessed by flow cytometry. RESULTS: In both the TBI+saline group and the TBI+AG490 group, the brain water content was elevated after TBI, reached a peak at 24-hour and remained high for the rest of the period investigated; the expression of CD40 reached a peak 24 hours after TBI; the NSS was elevated after TBI and then decreased after 6 hours. Elevations in the level of CD40, degree of brain edema and NSS after TBI were significantly reduced in TBI+AG490 group. CONCLUSION: Inhibition of the JAK/STAT signalling pathway reduces brain oedema, decreases the expression of CD40 and exerts neuroprotective effects after TBI.

PLK1 gene suppresses cell invasion of undifferentiated thyroid carcinoma through the inhibition of CD44v6, MMP-2 and MMP-9.

The aim of this study was to observe the regulatory action of the polo-like kinase 1 (PLK1) gene in the invasion of anaplastic thyroid carcinoma cells and investigate its mechanisms. The expression of the PLK1 protein in 36 patients with anaplastic thyroid carcinoma was detected by immunohistochemical staining. siRNA against PLK1 was designed, synthesized and transfected into ARO cells. The effects of PLK1 siRNA on cell invasion were detected by a soft agar colony formation assay and a Transwell chamber assay. The corresponding protein was detected using western blot analysis. The expression of PLK1 in anaplastic thyroid carcinoma samples (67.5±10.6%) was significantly higher compared to that in cancer-adjacent samples (0.65%±0.12%; P<0.01). The expression of PLK1 correlated with clinical stage, lymph node metastasis and prognosis of anaplastic thyroid. The number of cell clones was reduced in a dose-dependent manner with increasing levels of siRNA and the number of cells permeating through the filter membrane decreased following transfection with siRNA. The inhibition of PLK1 caused a significant decrease in CD44v6, matrix metalloproteinase (MMP)-2 and MMP-9 (0.36±0.08, 0.12±0.03, 0.25±0.06, respectively) compared to the non-transfected group (1.15±0.18, 1.21±0.20, 1.25±0.21, respectively; P<0.01). In conclusion, the expression of PLK1 was found to be increased in anaplastic thyroid carcinoma and was correlated with clinical stage, lymph node metastasis and prognosis. Additionaly, PLK1 siRNA was found to inhibit the invasion of anaplastic thyroid carcinoma cells. Therefore, CD44v6, MMP-2 and MMP-9 are likely to be involved in the regulation of cell invasion induced by PLK1.