Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the J...Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the Journal of Sport and Health Science,Liang et al.1 describe results from the UK Biobank data showing the benefits of moderate-to-vigorous intensity physical activity(MVPA)on reducing the risks for vascular events in 11,474 adults with T2D and prediabetes.展开更多
Type 2 diabetes mellitus(T2DM)is a metabolic disorder that currently affects more than 400 million worldwide and is projected to cause 552 million cases by the year 2030.Long-term vascular complications,such as corona...Type 2 diabetes mellitus(T2DM)is a metabolic disorder that currently affects more than 400 million worldwide and is projected to cause 552 million cases by the year 2030.Long-term vascular complications,such as coronary artery disease,myocardial infarction,stroke,are the leading causes of morbidity and mortality among diabetic patients.The recent advances in genome-wide technologies have given a powerful impetus to the study of risk markers for multifactorial diseases.To date,the role of genetic and epigenetic factors in modulating susceptibility to T2DM and its vascular complications is being successfully studied that provides the accumulation of genomic knowledge.In the future,this will provide an opportunity to reveal the pathogenetic pathways in the development of the disease and allow to predict the macrovascular complications in T2DM patients.This review is focused on the evidence of the role of genetic variants and epigenetic changes in the development of macrovascular pathology in diabetic patients.展开更多
Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus(DM).Highly publicized contro...Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus(DM).Highly publicized controversy surrounding cardiovascular(CV)safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications,which has resulted in revolutionary data from several large CV outcome trials over the last few years.All drugs in glucagon-like peptide-1 receptor agonist(GLP-1 RA)and sodium-glucose cotransporter-2(SGLT-2)inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy.Given twofold higher CV disease mortality in patients with DM than without DM,GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease.Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians,particularly primary care physicians,to stay updated with all the recent evidence.The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.展开更多
BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In ...BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment group.Comparisons were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse events.RESULTS In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627).There were no significant differences between the direct thrombectomy group(16.69±4.91 and 12.12±2.07)and the bridging group(7.13±1.23) and(14.40±0.59)in preoperative NIHSS score and GCS score(P=0.200 and 0.203,respectively).After the operation,the NIHSS scores in both groups were lower than those before the operation,and the GCS scores were higher than those before the operation.There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group(6.91±1.10 and 14.19±0.65)and the bridging group(7.13±1.23 and 14.40±0.59)(P=0.358 and 0.101,respectively).There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group(52.08%)and the bridging group(50.008%)(P=0.838).There was no significant difference in the incidence of adverse events between the direct thrombectomy group(6.25%)and the bridging group(8.33%)(P=0.913).CONCLUSION Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion,achieve good vascular recanalization effects and prognoses,and improve the neurological function of patients.展开更多
Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical a...Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical approaches.This study aimed to investigate whether computed tomography(CT)-based radiomics analysis could help predict development of MaVI in HCC.Methods:A cohort of 226 patients diagnosed with HCC was enrolled from 5 hospitals with complete MaVI and prognosis follow-ups.CT-based radiomics signature was built via multi-strategy machine learning methods.Afterwards,MaVI-related clinical factors and radiomics signature were integrated to construct the final prediction model(CRIM,clinical-radiomics integrated model)via random forest modeling.Cox-regression analysis was used to select independent risk factors to predict the time of MaVI development.Kaplan-Meier analysis was conducted to stratify patients according to the time of MaVI development,progression-free survival(PFS),and overall survival(OS)based on the selected risk factors.Results:The radiomics signature showed significant improvement for MaVI prediction compared with conventional clinical/radiological predictors(P<0.001).CRIM could predict MaVI with satisfactory areas under the curve(AUC)of 0.986 and 0.979 in the training(n=154)and external validation(n=72)datasets,respectively.CRIM presented with excellent generalization with AUC of 0.956,1.000,and 1.000 in each external cohort that accepted disparate CT scanning protocol/manufactory.Peel9_fos_InterquartileRange[hazard ratio(HR)=1.98;P<0.001]was selected as the independent risk factor.The cox-regression model successfully stratified patients into the high-risk and low-risk groups regarding the time of MaVI development(P<0.001),PFS(P<0.001)and OS(P=0.002).Conclusions:The CT-based quantitative radiomics analysis could enable high accuracy prediction of subsequent MaVI development in HCC with prognostic implications.展开更多
We investigated whether long-term glimepiride (GP) monotherapy improves insulin resistance and exerts a beneficial effect on beta cell function, as compared with glibenclamide (GC). One hundred Japanese Type 2 diabeti...We investigated whether long-term glimepiride (GP) monotherapy improves insulin resistance and exerts a beneficial effect on beta cell function, as compared with glibenclamide (GC). One hundred Japanese Type 2 diabetic patients were randomly assigned to the GP (n = 50) or the GC (n = 50) group. During a 5-year monitoring period, patients received the indicated SU monotherapy, while changes in SU doses were allowed as needed to maintain HbA1C below 7.0%. The GC group, in parallel with fasting insulin, showed a rapid homeostatic model assessment (HOMA)-R increase and maintained a high HOMA-R level. In contrast, HOMA-R in the GP group decreased continuously, from 2.9 at baseline to 1.8 at study completion. In the GC group, HOMA-b was markedly increased in the first 6 months, then gradually decreased through 18 months. While the HOMA-β elevation in the GP group was more moderate than that in the GC group, HOMA-β levels were maintained with a slight decrease. The cumulative macrovascular disease outcome was 1 for the GP and 7 for the GC group, showing a significant difference. These results suggest that glimepiride monotherapy markedly improved HOMA-R with moderate insulin stimulation, which may account for the difference in macrovascular disease development as compared with the group receiving glibenclamide.展开更多
BACKGROUND Diabetic macrovascular complications(DMCs)are the most common complications encountered during the course of diabetes mellitus(DM)with extremely high mortality rates.Therefore,there is an urgent need to ide...BACKGROUND Diabetic macrovascular complications(DMCs)are the most common complications encountered during the course of diabetes mellitus(DM)with extremely high mortality rates.Therefore,there is an urgent need to identify specific and sensitive biomarkers for the early diagnosis of DMCs.AIM To investigate the expression and significance of serum miR-129-5p in patients with DM and macrovascular complications.METHODS Serum samples were collected from 36 healthy controls,58 patients with DM presenting no macrovascular complications,and 62 patients with DMCs.The expression of miR-129-5p was detected using quantitative real-time polymerase chain reaction.Pearson’s correlation assay was performed to analyze the correlation between serum miR-129-5p levels and clinical indicators.Receiver operator characteristic(ROC)analysis was conducted to analyze the diagnostic value of serum miR-129-5p in patients with DM or DMCs.RESULTS There was a 4.378-fold and 7.369-fold increase in serum miR-129-5p expression in the DM(5.346±0.405)and DMCs(8.998±0.631)groups,respectively(P<0.001),compared with the control group(1.221±0.090).In addition,the expression of serum miR-129-5p in patients with DMCs was higher than that in patients with DM,revealing a 1.683-fold increase(P<0.001).Additionally,serum miR-129-5p expression significantly correlated with smoking history,disease duration,and glycated hemoglobin(HbA1c)in patients with DMCs(P<0.001).The area under the ROC curve(AUC)of miR-129-5p as a serum marker was 0.964(95%confidence interval[CI]:0.930-0.997,P<0.001)in distinguishing between patients with DM and healthy controls,whereas the AUC of miR-129-5p as a serum marker was 0.979(95%CI:0.959-0.999,P<0.001)in distinguishing between patients with DMCs and healthy controls.CONCLUSION Elevated serum miR-129-5p expression levels correlate with the development of DMCs and can be utilized as a novel early diagnostic biomarker for DM combined with macrovascular complications.展开更多
Objective ： To evaluate the changes of serum matrix metalloproteinase-9 （romp-9） in patients of incipient diabetic nephropathy with or without macrovascular disease and to analyze the factors associated with homocy...Objective ： To evaluate the changes of serum matrix metalloproteinase-9 （romp-9） in patients of incipient diabetic nephropathy with or without macrovascular disease and to analyze the factors associated with homocysteine（hcy）, interleukin-6（IL-6）, tumor necrosis factor-alpha （TNF-α）, highly sensitive C-reactive protein （hsCRP）, HbAlc and lipid profile in those patients in order to know whether this marker or other factors are more important to induce diabetic macrovascular disease. Methods： Type 2 diabetes mellitus（T2DM） subjects with incipient diabetic nephropathy with or without macrovascular disease were selected for participation and divided into 2 groups. The patients in group 1 （n= 38） used insulin, and patients in group 2 （n=34） were treated with an oral antidiabetic drug. Then serum mmp-9, hey, IL-6 and TNF-α in these patients were measured, and compared to the healthy subjects as control （n= 16）. The results were analyzed by SPSS13. Results： Serum romp-9 and hcy of the patients having incipient diabetic nephropathy with macrovascular disease were higher than that of patients without macrovascular disease （P〈0.01）. For insulin-injected patients, whether they accompanied with macrovascular diseases or not, the serum levels of romp-9, hcy, IL-6 and TNF-α were all lower, but no significant statistics compared with non-insulin used patients or the healthy subjects. The serum level of romp-9 was more correlated with the serum hcy in antidiabetic drug used patients. （P〈0. 000） Conclusion： The serum level of romp-9 plays an important role of pathogenesis in the macrovascular disease in the incipient diabetic patients, and the serum level of hcy also can reflect the severely degree of macrovascular disease in these patients, insulin can reduce these markers.展开更多
Objective The association between neutrophil-to-lymphocyte ratio(NLR)with subclinical macrovascular and microvascular diseases has been less investigated.We sought to examine the association between NLR and new-onset ...Objective The association between neutrophil-to-lymphocyte ratio(NLR)with subclinical macrovascular and microvascular diseases has been less investigated.We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.Methods From a community cohort,we included 6,430 adults aged≥40 years without subclinical macrovascular and microvascular diseases at baseline.We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index(ABI),brachial-ankle pulse wave velocity(baPWV),and albuminuria.Results During a mean follow-up of 4.3 years,110 participants developed incident abnormal ABI,746 participants developed incident elevated baPWV,and 503 participants developed incident albuminuria.Poisson regression analysis indicated that NLR was significantly associated with an increased risk of newonset abnormal ABI,elevated baPWV,and albuminuria.Compared to overweight/obese participants,we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight.Furthermore,we found an interaction between the NLR and body mass index(BMI)on the risk of new-onset abnormal ABI(P for interaction:0.01).Conclusion NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population.Furthermore,in participants with normal weight,the association between NLR and subclinical vascular abnormalities was much stronger.展开更多
Objective:To investigate the effect of Shenqi Compound Formula (SCF) on peroxisome proliferators-activated receptor γ (PPARγ) in white adipose tissue of rats with macrovascular lesion in early stage of diabetes. Met...Objective:To investigate the effect of Shenqi Compound Formula (SCF) on peroxisome proliferators-activated receptor γ (PPARγ) in white adipose tissue of rats with macrovascular lesion in early stage of diabetes. Methods: Corresponding treatment was given to rats in model group, Ramipril group, normal control group, low dosage SCF group and high dosage SCF group respectively for 32 days. The expressions of PPARγ and adiponectin Messenger RNA (mRNA) were detected by real-time reverse transcriptase poly-merase chain reaction. Results: The expressions of PPARγ and adiponectin mRNA increased significantly in both low and high dosage SCF groups as compared with the model group, and a positive linear correlation was found between the expressions of PPARγ and adiponectin mRNA. Conclusions: SCF can prevent macrovascular lesion in early stage of diabetes, which is possibly related with up-regulating expressions of PPARγ and activating PPARγ.展开更多
Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at...Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at T2D diagnosis in Yaoundé, Cameroon. Materials and Methods: We conducted a cross-sectional study at the Essos Hospital Center in Yaoundé from January 2017 to June 2021. We recruited patients newly diagnosed with T2D who, simultaneously, with assessed macrovascular complications including stroke, myocardial infarction (MI) and arterial foot ulcer (AFU). Correlates were investigated using Chi square test and logistic regressions. The significance level was set at 5%. Results: In all, 286 newly diagnosed diabetic patients (51.7% being men) were included. The mean age was 52.6 ± 12.3 years. Prevalent cardiovascular risk factors at diabetes diagnosis were a dyslipidemia (63.6%), sedentary lifestyle (57.7%) and family history of type 2 diabetes (51.6%). The prevalence of macrovascular complications was 17.5% with 8.4% stroke, 5.6% myocardial infarction and 3.4% arterial foot ulcer. Hypertension was associated with all macrovascular complications (p Conclusion: Macrovascular complications are frequent at type 2 diabetes diagnosis and are represented by stroke and myocardial infarction in our study, highlighting the importance of cardiovascular risk evaluation and reduction in people with diabetes right from diagnosis.展开更多
Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients wit...Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.展开更多
Objective To investigate the expression and regulatory role of adenosine triphosphate binding transporter C4(ABCC4) in patients with type 2 diabetes mellitus(T2DM) and macrovascular disease (MD).Methods A total of 137...Objective To investigate the expression and regulatory role of adenosine triphosphate binding transporter C4(ABCC4) in patients with type 2 diabetes mellitus(T2DM) and macrovascular disease (MD).Methods A total of 137 patients with T2DM were enrolled in this study from Zhongnan Hospital of Wuhan University during March 2015 and March 2017.展开更多
Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researcher...Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researchers for their established role in inflammatory conditions.In this respect,T2DM and its mi-crovascular complications are characterized by high inflammatory burden.Hence,recent studies in the literature have reported an association between T2DM and hemogram-derived markers.Emerging evidence highlights the utility of hemo-gram-derived markers,including the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,red cell distribution width,and mean platelet volume,as potential predictors of T2DM onset and progression.These markers,readily available from routine hemogram tests,offer valuable insights into the systemic inflammation and vascular changes associated with T2DM and its complications,such as cardiovascular disease,nephropathy,and retinopathy.This review syn-thesizes current research on the association between hemogram-derived markers and T2DM,emphasizing their prognostic value in predicting disease severity and complications.We also explore the underlying pathophysiological mechanisms linking these markers to inflammation and metabolic dysfunction.The findings suggest that hemogram-derived markers could serve as cost-effective,non-invasive tools for risk stratification and early intervention in T2DM management.Future research should focus on standardizing reference ranges and validating these markers in diverse populations to enhance their clinical utility.展开更多
KCNQ1 has been identified as a susceptibility gene of type 2 diabetes mellitus （T2DM） in Asian populations through genome-wide association studies. However, studies on the association between gene polymorphism of KC...KCNQ1 has been identified as a susceptibility gene of type 2 diabetes mellitus （T2DM） in Asian populations through genome-wide association studies. However, studies on the association between gene polymorphism of KCNQ1 and T2DM complications remain unclear. To further ana- lyze the association between different alleles at the single nncleotide polymorphism （SNP） rs2237892 within KCNQ1 and TD2M and its complications, we conducted a case-control study in a Chinese Han population. The C allele of rs2237892 variant contributed to susceptibility to T2DM （odds ratio [OR], 1.45; 95% confidence interval [CI], 1.20 1.75）. Genotypes CT （OR, 1.97; 95% CI, 1.24-3.15） and CC （OR, 2.49; 95% CI, 1.57-3.95） were associated with an increased risk of T2DM. Multivariate regression analysis was performed with adjustment of age, gender, and body mass index. We found that systolic blood pressure （P = 0.015）, prevalence of hypertension （P = 0.037）, and risk of maerovascnlar disease （OR, 2.10; CI, 1.00-4.45） were significantly higher in subjects with the CC genotype than in the combined population with genotype either CT or TT. Therefore, our data support that KCNQ1 might contribute to the higher incidence of patients with T2DM carrying the risk allele C population. is associated with an increased risk for T2DM and hypertension and macrovascular complications in though it needs further to be confirmed in a larger展开更多
Background The most intimidatory pathological changes in patients with DM are cardiovascular illnesses, which are the major causes of death in diabetic patients and are far more prevalent than in nondiabetics because...Background The most intimidatory pathological changes in patients with DM are cardiovascular illnesses, which are the major causes of death in diabetic patients and are far more prevalent than in nondiabetics because of accelerated atherosclerosis In this study, we tried to clarify the changes in macrovascular endothelial ultrastructure and in the gene expression of endothelial nitric oxide synthase (eNOS)mRNA in diabetic rats KH*2/5DMethods The study was conducted on 52 of 10-week old Sprague Dawley (SD) rats with body weight of (320±42) g SD rats were divided into: experimental group treated with a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg), (male, n=20, diabetes mellitus (DMM)); female, n=12, diabetes mellitus female (DMF)) and control group (male, n=10, diabetes mellitus male control (DMMC); female, n=10, diabetes mellitus female control (DMFC)) Four weeks after treatment, half of the rats were sacrificed; the remainders were sacrificed ten weeks after treatment One part of the abdominal aortic sample was stored under glutaraldehyde (volume fraction ψ B = 2 5 %) After the process of chemical fixation, chemical dehydration, drying and conductivity enhancement, all samples were observed and photographed using scanning electron microscopy (Leica-Stereoscan 260, England) The other part of the abdominal aortic sample was treated with liquid nitrogen and the expression of eNOSmRNA was assessed by semi-quantitative RT-PCR Results The aortic lumen of both experimental groups adsorbed much more debris than that of either control group The endothelial surfaces of diabetic rats were coarse, wrinkled and protuberant like fingers or villi The vascular endothelial lesions of diabetic male rats were very distinct after 4 weeks, and as obvious as those at 10 weeks The vascular endothelial lesions of diabetic female rats were not severe at 4 weeks and only became marked after 10 weeks In both males and females, the abdominal aortic eNOSmRNA content of 4 weeks and 10 weeks diabetic rats was very significantly lower ( P <0 01) than that of controls Conclusions Aortic endothelial ultrastructure in DM rats is injured compared with controls Abnormal changes of aortic endothelia in male DM rats are more obvious than those in females Expression of abdominal aortic eNOSmRNA content of DM rats is significantly lower than that of controls展开更多
文摘Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the Journal of Sport and Health Science,Liang et al.1 describe results from the UK Biobank data showing the benefits of moderate-to-vigorous intensity physical activity(MVPA)on reducing the risks for vascular events in 11,474 adults with T2D and prediabetes.
基金Supported by Ministry of Science and Higher Education of the Russian Federation within the Applied Science Research Program,No.AAAA-A20-120041390028-0Estonia-Russia Cross Border Cooperation Programme 2014-2020,No.ER24.
文摘Type 2 diabetes mellitus(T2DM)is a metabolic disorder that currently affects more than 400 million worldwide and is projected to cause 552 million cases by the year 2030.Long-term vascular complications,such as coronary artery disease,myocardial infarction,stroke,are the leading causes of morbidity and mortality among diabetic patients.The recent advances in genome-wide technologies have given a powerful impetus to the study of risk markers for multifactorial diseases.To date,the role of genetic and epigenetic factors in modulating susceptibility to T2DM and its vascular complications is being successfully studied that provides the accumulation of genomic knowledge.In the future,this will provide an opportunity to reveal the pathogenetic pathways in the development of the disease and allow to predict the macrovascular complications in T2DM patients.This review is focused on the evidence of the role of genetic variants and epigenetic changes in the development of macrovascular pathology in diabetic patients.
文摘Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus(DM).Highly publicized controversy surrounding cardiovascular(CV)safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications,which has resulted in revolutionary data from several large CV outcome trials over the last few years.All drugs in glucagon-like peptide-1 receptor agonist(GLP-1 RA)and sodium-glucose cotransporter-2(SGLT-2)inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy.Given twofold higher CV disease mortality in patients with DM than without DM,GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease.Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians,particularly primary care physicians,to stay updated with all the recent evidence.The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.
文摘BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment group.Comparisons were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse events.RESULTS In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627).There were no significant differences between the direct thrombectomy group(16.69±4.91 and 12.12±2.07)and the bridging group(7.13±1.23) and(14.40±0.59)in preoperative NIHSS score and GCS score(P=0.200 and 0.203,respectively).After the operation,the NIHSS scores in both groups were lower than those before the operation,and the GCS scores were higher than those before the operation.There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group(6.91±1.10 and 14.19±0.65)and the bridging group(7.13±1.23 and 14.40±0.59)(P=0.358 and 0.101,respectively).There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group(52.08%)and the bridging group(50.008%)(P=0.838).There was no significant difference in the incidence of adverse events between the direct thrombectomy group(6.25%)and the bridging group(8.33%)(P=0.913).CONCLUSION Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion,achieve good vascular recanalization effects and prognoses,and improve the neurological function of patients.
基金supported by grants from the National Key R&D Program of China(2017YFA0205200,2017YFC1308701,and 2017YFC1309100)National Natural Science Foundation of China(82001917,81930053,81227901,81771924,81501616,81571785,81771957,and 61671449)the Natural Science Foundation of Guangdong Province,China(2016A030311055 and 2016A030313770)。
文摘Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical approaches.This study aimed to investigate whether computed tomography(CT)-based radiomics analysis could help predict development of MaVI in HCC.Methods:A cohort of 226 patients diagnosed with HCC was enrolled from 5 hospitals with complete MaVI and prognosis follow-ups.CT-based radiomics signature was built via multi-strategy machine learning methods.Afterwards,MaVI-related clinical factors and radiomics signature were integrated to construct the final prediction model(CRIM,clinical-radiomics integrated model)via random forest modeling.Cox-regression analysis was used to select independent risk factors to predict the time of MaVI development.Kaplan-Meier analysis was conducted to stratify patients according to the time of MaVI development,progression-free survival(PFS),and overall survival(OS)based on the selected risk factors.Results:The radiomics signature showed significant improvement for MaVI prediction compared with conventional clinical/radiological predictors(P<0.001).CRIM could predict MaVI with satisfactory areas under the curve(AUC)of 0.986 and 0.979 in the training(n=154)and external validation(n=72)datasets,respectively.CRIM presented with excellent generalization with AUC of 0.956,1.000,and 1.000 in each external cohort that accepted disparate CT scanning protocol/manufactory.Peel9_fos_InterquartileRange[hazard ratio(HR)=1.98;P<0.001]was selected as the independent risk factor.The cox-regression model successfully stratified patients into the high-risk and low-risk groups regarding the time of MaVI development(P<0.001),PFS(P<0.001)and OS(P=0.002).Conclusions:The CT-based quantitative radiomics analysis could enable high accuracy prediction of subsequent MaVI development in HCC with prognostic implications.
文摘We investigated whether long-term glimepiride (GP) monotherapy improves insulin resistance and exerts a beneficial effect on beta cell function, as compared with glibenclamide (GC). One hundred Japanese Type 2 diabetic patients were randomly assigned to the GP (n = 50) or the GC (n = 50) group. During a 5-year monitoring period, patients received the indicated SU monotherapy, while changes in SU doses were allowed as needed to maintain HbA1C below 7.0%. The GC group, in parallel with fasting insulin, showed a rapid homeostatic model assessment (HOMA)-R increase and maintained a high HOMA-R level. In contrast, HOMA-R in the GP group decreased continuously, from 2.9 at baseline to 1.8 at study completion. In the GC group, HOMA-b was markedly increased in the first 6 months, then gradually decreased through 18 months. While the HOMA-β elevation in the GP group was more moderate than that in the GC group, HOMA-β levels were maintained with a slight decrease. The cumulative macrovascular disease outcome was 1 for the GP and 7 for the GC group, showing a significant difference. These results suggest that glimepiride monotherapy markedly improved HOMA-R with moderate insulin stimulation, which may account for the difference in macrovascular disease development as compared with the group receiving glibenclamide.
基金Supported by National Natural Science Foundation of China,No.81903032China Postdoctoral Science Foundation,No.2020M672520+1 种基金Research Prgram of Hunan Health Commission,China,No.202103030659Youth Fund of Xiangya Hospital,No.2018Q011.
文摘BACKGROUND Diabetic macrovascular complications(DMCs)are the most common complications encountered during the course of diabetes mellitus(DM)with extremely high mortality rates.Therefore,there is an urgent need to identify specific and sensitive biomarkers for the early diagnosis of DMCs.AIM To investigate the expression and significance of serum miR-129-5p in patients with DM and macrovascular complications.METHODS Serum samples were collected from 36 healthy controls,58 patients with DM presenting no macrovascular complications,and 62 patients with DMCs.The expression of miR-129-5p was detected using quantitative real-time polymerase chain reaction.Pearson’s correlation assay was performed to analyze the correlation between serum miR-129-5p levels and clinical indicators.Receiver operator characteristic(ROC)analysis was conducted to analyze the diagnostic value of serum miR-129-5p in patients with DM or DMCs.RESULTS There was a 4.378-fold and 7.369-fold increase in serum miR-129-5p expression in the DM(5.346±0.405)and DMCs(8.998±0.631)groups,respectively(P<0.001),compared with the control group(1.221±0.090).In addition,the expression of serum miR-129-5p in patients with DMCs was higher than that in patients with DM,revealing a 1.683-fold increase(P<0.001).Additionally,serum miR-129-5p expression significantly correlated with smoking history,disease duration,and glycated hemoglobin(HbA1c)in patients with DMCs(P<0.001).The area under the ROC curve(AUC)of miR-129-5p as a serum marker was 0.964(95%confidence interval[CI]:0.930-0.997,P<0.001)in distinguishing between patients with DM and healthy controls,whereas the AUC of miR-129-5p as a serum marker was 0.979(95%CI:0.959-0.999,P<0.001)in distinguishing between patients with DMCs and healthy controls.CONCLUSION Elevated serum miR-129-5p expression levels correlate with the development of DMCs and can be utilized as a novel early diagnostic biomarker for DM combined with macrovascular complications.
文摘Objective ： To evaluate the changes of serum matrix metalloproteinase-9 （romp-9） in patients of incipient diabetic nephropathy with or without macrovascular disease and to analyze the factors associated with homocysteine（hcy）, interleukin-6（IL-6）, tumor necrosis factor-alpha （TNF-α）, highly sensitive C-reactive protein （hsCRP）, HbAlc and lipid profile in those patients in order to know whether this marker or other factors are more important to induce diabetic macrovascular disease. Methods： Type 2 diabetes mellitus（T2DM） subjects with incipient diabetic nephropathy with or without macrovascular disease were selected for participation and divided into 2 groups. The patients in group 1 （n= 38） used insulin, and patients in group 2 （n=34） were treated with an oral antidiabetic drug. Then serum mmp-9, hey, IL-6 and TNF-α in these patients were measured, and compared to the healthy subjects as control （n= 16）. The results were analyzed by SPSS13. Results： Serum romp-9 and hcy of the patients having incipient diabetic nephropathy with macrovascular disease were higher than that of patients without macrovascular disease （P〈0.01）. For insulin-injected patients, whether they accompanied with macrovascular diseases or not, the serum levels of romp-9, hcy, IL-6 and TNF-α were all lower, but no significant statistics compared with non-insulin used patients or the healthy subjects. The serum level of romp-9 was more correlated with the serum hcy in antidiabetic drug used patients. （P〈0. 000） Conclusion： The serum level of romp-9 plays an important role of pathogenesis in the macrovascular disease in the incipient diabetic patients, and the serum level of hcy also can reflect the severely degree of macrovascular disease in these patients, insulin can reduce these markers.
基金supported by the grants from the National Key R&D Program of China[2017YFC1310700,2016YFC1305600,2016YFC0901200,2016YFC1305202,2016YFC1304904,2018YFC1311800,2018YFC1311705]the National Natural Science Foundation of China[81870560,81561128019,81621061,81700764,81941017,81770842]+9 种基金the Chinese Academy of Medical Sciences[2018PT32017,2019PT330006]the Shanghai Municipal Government[18411951800]the Shanghai Shenkang Hospital Development Center[SHDC12019101]Shanghai Municipal Commission of Health and Family Planning[20174Y0014]National Major Scientific and Technological Special Project for“Significant New Drugs Development”[2017ZX09304007]Shanghai Rising-Star Program[21QA1408100]the Scientific and Technological Committee of Shanghai[19411964200]Innovative research team of high-level local universities in Shanghaithe Shanghai Jiaotong University School of Medicine[DLY201801,20161301,20161307]the Ruijin Hospital[2018CR002]。
文摘Objective The association between neutrophil-to-lymphocyte ratio(NLR)with subclinical macrovascular and microvascular diseases has been less investigated.We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.Methods From a community cohort,we included 6,430 adults aged≥40 years without subclinical macrovascular and microvascular diseases at baseline.We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index(ABI),brachial-ankle pulse wave velocity(baPWV),and albuminuria.Results During a mean follow-up of 4.3 years,110 participants developed incident abnormal ABI,746 participants developed incident elevated baPWV,and 503 participants developed incident albuminuria.Poisson regression analysis indicated that NLR was significantly associated with an increased risk of newonset abnormal ABI,elevated baPWV,and albuminuria.Compared to overweight/obese participants,we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight.Furthermore,we found an interaction between the NLR and body mass index(BMI)on the risk of new-onset abnormal ABI(P for interaction:0.01).Conclusion NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population.Furthermore,in participants with normal weight,the association between NLR and subclinical vascular abnormalities was much stronger.
文摘Objective:To investigate the effect of Shenqi Compound Formula (SCF) on peroxisome proliferators-activated receptor γ (PPARγ) in white adipose tissue of rats with macrovascular lesion in early stage of diabetes. Methods: Corresponding treatment was given to rats in model group, Ramipril group, normal control group, low dosage SCF group and high dosage SCF group respectively for 32 days. The expressions of PPARγ and adiponectin Messenger RNA (mRNA) were detected by real-time reverse transcriptase poly-merase chain reaction. Results: The expressions of PPARγ and adiponectin mRNA increased significantly in both low and high dosage SCF groups as compared with the model group, and a positive linear correlation was found between the expressions of PPARγ and adiponectin mRNA. Conclusions: SCF can prevent macrovascular lesion in early stage of diabetes, which is possibly related with up-regulating expressions of PPARγ and activating PPARγ.
文摘Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at T2D diagnosis in Yaoundé, Cameroon. Materials and Methods: We conducted a cross-sectional study at the Essos Hospital Center in Yaoundé from January 2017 to June 2021. We recruited patients newly diagnosed with T2D who, simultaneously, with assessed macrovascular complications including stroke, myocardial infarction (MI) and arterial foot ulcer (AFU). Correlates were investigated using Chi square test and logistic regressions. The significance level was set at 5%. Results: In all, 286 newly diagnosed diabetic patients (51.7% being men) were included. The mean age was 52.6 ± 12.3 years. Prevalent cardiovascular risk factors at diabetes diagnosis were a dyslipidemia (63.6%), sedentary lifestyle (57.7%) and family history of type 2 diabetes (51.6%). The prevalence of macrovascular complications was 17.5% with 8.4% stroke, 5.6% myocardial infarction and 3.4% arterial foot ulcer. Hypertension was associated with all macrovascular complications (p Conclusion: Macrovascular complications are frequent at type 2 diabetes diagnosis and are represented by stroke and myocardial infarction in our study, highlighting the importance of cardiovascular risk evaluation and reduction in people with diabetes right from diagnosis.
基金Projects of Natural Science Foundation of Tibet Autonomous Region.Project No:2015ZR-13-16.
文摘Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.
文摘Objective To investigate the expression and regulatory role of adenosine triphosphate binding transporter C4(ABCC4) in patients with type 2 diabetes mellitus(T2DM) and macrovascular disease (MD).Methods A total of 137 patients with T2DM were enrolled in this study from Zhongnan Hospital of Wuhan University during March 2015 and March 2017.
文摘Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researchers for their established role in inflammatory conditions.In this respect,T2DM and its mi-crovascular complications are characterized by high inflammatory burden.Hence,recent studies in the literature have reported an association between T2DM and hemogram-derived markers.Emerging evidence highlights the utility of hemo-gram-derived markers,including the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,red cell distribution width,and mean platelet volume,as potential predictors of T2DM onset and progression.These markers,readily available from routine hemogram tests,offer valuable insights into the systemic inflammation and vascular changes associated with T2DM and its complications,such as cardiovascular disease,nephropathy,and retinopathy.This review syn-thesizes current research on the association between hemogram-derived markers and T2DM,emphasizing their prognostic value in predicting disease severity and complications.We also explore the underlying pathophysiological mechanisms linking these markers to inflammation and metabolic dysfunction.The findings suggest that hemogram-derived markers could serve as cost-effective,non-invasive tools for risk stratification and early intervention in T2DM management.Future research should focus on standardizing reference ranges and validating these markers in diverse populations to enhance their clinical utility.
基金supported by the National Natural Science Foundation of China(Grant No. 81271918)Zhejiang Provincial Natural Science Foundation of China (Grant No. Y2090753)+2 种基金Key Science and Technology Innovation Team of Zhejiang Province (Grant No. 2010R50048)Zhejiang Provincial Program for the Cultivation of High-level Innovative Health Talentsthe Medical Scientific Projects from the Health Bureau of Zhejiang Province (Grant No. 2011ZDA016)
文摘KCNQ1 has been identified as a susceptibility gene of type 2 diabetes mellitus （T2DM） in Asian populations through genome-wide association studies. However, studies on the association between gene polymorphism of KCNQ1 and T2DM complications remain unclear. To further ana- lyze the association between different alleles at the single nncleotide polymorphism （SNP） rs2237892 within KCNQ1 and TD2M and its complications, we conducted a case-control study in a Chinese Han population. The C allele of rs2237892 variant contributed to susceptibility to T2DM （odds ratio [OR], 1.45; 95% confidence interval [CI], 1.20 1.75）. Genotypes CT （OR, 1.97; 95% CI, 1.24-3.15） and CC （OR, 2.49; 95% CI, 1.57-3.95） were associated with an increased risk of T2DM. Multivariate regression analysis was performed with adjustment of age, gender, and body mass index. We found that systolic blood pressure （P = 0.015）, prevalence of hypertension （P = 0.037）, and risk of maerovascnlar disease （OR, 2.10; CI, 1.00-4.45） were significantly higher in subjects with the CC genotype than in the combined population with genotype either CT or TT. Therefore, our data support that KCNQ1 might contribute to the higher incidence of patients with T2DM carrying the risk allele C population. is associated with an increased risk for T2DM and hypertension and macrovascular complications in though it needs further to be confirmed in a larger
文摘Background The most intimidatory pathological changes in patients with DM are cardiovascular illnesses, which are the major causes of death in diabetic patients and are far more prevalent than in nondiabetics because of accelerated atherosclerosis In this study, we tried to clarify the changes in macrovascular endothelial ultrastructure and in the gene expression of endothelial nitric oxide synthase (eNOS)mRNA in diabetic rats KH*2/5DMethods The study was conducted on 52 of 10-week old Sprague Dawley (SD) rats with body weight of (320±42) g SD rats were divided into: experimental group treated with a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg), (male, n=20, diabetes mellitus (DMM)); female, n=12, diabetes mellitus female (DMF)) and control group (male, n=10, diabetes mellitus male control (DMMC); female, n=10, diabetes mellitus female control (DMFC)) Four weeks after treatment, half of the rats were sacrificed; the remainders were sacrificed ten weeks after treatment One part of the abdominal aortic sample was stored under glutaraldehyde (volume fraction ψ B = 2 5 %) After the process of chemical fixation, chemical dehydration, drying and conductivity enhancement, all samples were observed and photographed using scanning electron microscopy (Leica-Stereoscan 260, England) The other part of the abdominal aortic sample was treated with liquid nitrogen and the expression of eNOSmRNA was assessed by semi-quantitative RT-PCR Results The aortic lumen of both experimental groups adsorbed much more debris than that of either control group The endothelial surfaces of diabetic rats were coarse, wrinkled and protuberant like fingers or villi The vascular endothelial lesions of diabetic male rats were very distinct after 4 weeks, and as obvious as those at 10 weeks The vascular endothelial lesions of diabetic female rats were not severe at 4 weeks and only became marked after 10 weeks In both males and females, the abdominal aortic eNOSmRNA content of 4 weeks and 10 weeks diabetic rats was very significantly lower ( P <0 01) than that of controls Conclusions Aortic endothelial ultrastructure in DM rats is injured compared with controls Abnormal changes of aortic endothelia in male DM rats are more obvious than those in females Expression of abdominal aortic eNOSmRNA content of DM rats is significantly lower than that of controls
