Evaluation of increased arterial stiffness in pediatric patients with cystic fibrosis by augmentation index and pulse wave velocity analysis

With the increase in life expectancy, cardiovascular complications of cystic fibrosis (CF) have come to the forefront. Increased arterial stiffness is a marker of increased cardiovascular risk. The aim of this study was to compare both pulse wave velocity (PWV) and augmentation index (Aix) measurements in children with CF and to compare them with healthy controls. We hypothesized that children with CF had increased arterial stiffness, although traditional risk factors for CVD were not observed. Forty‐four patients and age and sex‐matched 30 healthy controls were included in the study. Hemodynamic measurements were compared in both groups, together with traditional risk factors. Peripheral blood pressure parameters of CF and control groups were similar (P > .05). Bodyweight and BMI were significantly lower in the CF group (P < .001). Serum cholesterol, HDL, and LDL levels were significantly lower in the CF group, whereas fasting blood glucose and triglyceride levels were significantly higher than the control group (P < .05). Mean ± SD Aix was significantly higher in the CF group (33.22 ± 13.87%) compared with the control group (24.93 ± 10.58%), respectively (P < .05), while PWV was similar. No significant correlation between PWV and Aix and fasting blood glucose and lipid profile in both groups (P > .05). Children with CF have been shown to have increased arterial stiffness compared to healthy children. Although there are not many traditional risk factors, increased arterial stiffness have been demonstrated in children with CF. The effects of this process starting from childhood on the development of CVD in adulthood are not known. Therefore, further studies are needed.     

Peripheral Artery Disease and Risk of Fibrosis Deterioration in Nonalcoholic Fatty Liver Disease: A Prospective Investigation

Objective Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease(NAFLD). Peripheral artery disease(PAD) and liver fibrosis share many common metabolic dysfunctions.We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients.Methods The study recruited 1,610 NAFLD patients aged ≥ 40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015. Fibrosis deterioration was defined as the NAFLD fibrosis score(NFS) status increased to a higher category at the follow-up visit.PAD was defined as an ankle-brachial index of 0.90 or 1.40.Results During an average of 4.3 years' follow-up, 618 patients progressed to a higher NFS category.PAD was associated with 92% increased risk of fibrosis deterioration [multivariable-adjusted odds ratio(OR): 1.92, 95% confidence interval(CI): 1.24, 2.98]. When stratified by baseline NFS status, the OR for progression from low to intermediate or high NFS was 1.74(95% CI: 1.02, 3.00), and progression from intermediate to high NFS was 2.24(95% CI: 1.05, 4.80). There was a significant interaction between PAD and insulin resistance(IR) on fibrosis deterioration(P for interaction = 0.03). As compared with non-PAD and non-IR, the coexistence of PAD and IR was associated with a 3.85-fold(95% CI: 2.06, 7.18) increased risk of fibrosis deterioration.Conclusion PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients,especially in those with IR. The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.     

肌骨超声在痛风性关节炎急性发作期的应用价值及与血液指标的相关性

目的 探讨肌骨超声在痛风性关节炎急性发作期的应用价值及与血液指标的相关性。方法 选择2019年1~12月江苏省盐城市第三人民医院健康体检的50例老年人群作为健康对照组,以本院同期收治的107例痛风性关节炎老年人群作为病例观察组,根据临床症状及病史问询结果,病例观察组分为急性发作组（44例）与稳定期组（63例）。所有患者均行关节肌骨超声检查和病情相关血液指标检查,分析肌骨超声评分与病情相关血液指标的相关性。结果 健康对照组、稳定期组、急性发作组患者的肌骨超声综合评分差异有统计学意义（P<0.05）。肌骨超声综合评分鉴别诊断痛风性关节炎的的曲线下面积（AUC）为0.885,准确度、敏感度、特异度分别为71.44%、77.25%和73.61%（P<0.001）,肌骨超声综合评分的鉴别阈值为4.38分。肌骨超声综合评分鉴别诊断痛风性关节炎稳定期与急性发作期的的AUC为0.861,准确度、敏感度、特异度分别为70.81%、76.36%和71.49%（P<0.001）,肌骨超声综合评分的鉴别阈值为8.89分。急性发作痛风性关节炎患者肌骨超声综合评分与5-羟色胺、P物质和超敏C-反应蛋白、白细胞介素-6及肿瘤坏死因子-α均呈正相关（P<0.05）。结论 肌骨超声综合评分与病情相关血液指标具有相关性,肌骨超声在鉴别痛风性关节炎急性发作和稳定期鉴别中具有一定的临床价值。     

Emotional Eating Moderates the Relationship of Night Eating with Binge Eating and Body Mass

Night eating syndrome is marked by substantial evening or nocturnal food intake, insomnia, morning anorexia, and depressed mood. Night eating severity has been positively associated with body mass index (BMI), binge eating frequency, and emotional eating tendencies. We conducted an online questionnaire study among students (N = 729) and explored possible interactive effects between those variables. Night eating severity, binge eating frequency, BMI and emotional eating were all positively correlated with each other. Regression analyses showed that night eating severity was particularly related to more frequent binge episodes and higher BMI at high levels of emotional eating but unrelated to those variables at low levels of emotional eating. Thus, eating as a means of emotion regulation appears to be an important moderator of the relationship between night eating and both binge eating and BMI. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Mitomycin‐C: ‘a ray of hope’ in refractory corrosive esophageal strictures

Increasingly frequent dilation may become a self‐defeating cycle in refractory stricture as recurrent trauma enhance, scar formation, and ultimately recurrence and potential worsening of the stricture. In 12 patients of caustic induced esophageal stricture, who failed to respond despite rigorous dilatation regimen for more than one year, a trial of topical mitomycin‐C application to improve dilatation results was undertaken, considering the recently reported efficacy and safety of this agent. Mitomycin‐C was applied for 2–3 minutes at the strictured esophageal segment after dilation with wire‐guided Savary‐Gilliard dilator. Patient was kept nil by mouth for 2–3 hours. After 4–6 sessions of mitomycin‐C treatment, resolution of symptoms and significant improvement in dysphagia score and periodic dilatation index was seen in all 12 patients. Mitomycin‐C topical application may be a useful strategy in refractory corrosive esophageal strictures and salvage patients from surgery.     

Impact of flexible insulin therapy on blood glucose variability,oxidative stress and inflammation in type 1 diabetic patients: The VARIAFIT study

AimsHbA_1c only partially predicts vascular risk in patients with type 1 diabetes (T1D), and a role for blood glucose variability (BGV) is a matter of debate. For this reason, this study investigated the impact of an educational programme of flexible insulin therapy (FIT) on BGV and oxidative stress.MethodsTests were conducted on 30 adult T1D patients in a prospective, single-centre trial at baseline (M0), and at 3 and 6 months (M3 and M6, respectively) of the FIT programme to determine BGV, as reflected by mean amplitude of glycaemic excursions (MAGE), low blood glucose index (LBGI), lability index (LI), average daily risk range (ADRR), glycaemic lability (scored by two diabetologists), urinary leukotriene E₄ (LTE4), 11-dehydro-thromboxane B₂ (TXB2) and 8-iso-prostaglandin F2α (PGF2).ResultsHbA_1c (7.7 ± 0.9%), ADRR, MAGE, LBGI and LI did not change from M0 to M3 and M6, although ADRR and LBGI significantly improved at M3 and M6 in patients with the highest baseline indices (≥ 40 and ≥ 5, respectively). TXB2 declined at M6 (832 ± 625 vs. 633 ± 972 pg/mg; P = 0.048), whereas LTE4 and PGF2 remained stable. ADRR showed the strongest correlation with glycaemic lability scores at all visits (r ≥ 0.84, P < 0.0001).ConclusionA FIT educational programme improved BGV only in patients with the highest baseline variability, and led to no changes in HbA_1c, while ADRR closely correlated with glycaemic lability score. Our data do not support a relationship between BGV and oxidative stress in T1D patients, although the impact of variability on TXB2 deserves further investigation (ClinicalTrials.gov NCT00973492).     

The role of disease severity in influencing body mass index in people with haemophilia: a single‐institutional cross‐sectional study

The aim of this study was to evaluate the effect of haemophilia disease severity and potential intermediaries on body mass index (BMI) in patients with haemophilia. A secondary analysis of a cross‐sectional study of 88 adults with haemophilia was undertaken. On bivariate analysis, persons with severe haemophilia had 9.8% lower BMI (95% CI ?17.1, ?3.0) than persons with non‐severe haemophilia. The effect of haemophilia severity on BMI varied significantly by human immunodeficiency virus (HIV) status. Among HIV‐positive subjects, haemophilia severity was not associated with BMI (+5.0%, 95% CI ?22.4, 41.9). Among HIV‐negative subjects, severe haemophilia was associated with 15.1% lower BMI (95% CI, ?23.6, ?5.7). Older (>41 years) HIV‐negative subjects with severe haemophilia had a BMI that was 24.8% lower (95% CI ?39.1, ?7.0) than those with non‐severe haemophilia. No statistically significant association was detected between BMI and severe vs. non‐severe haemophilia for younger HIV‐negative subjects. Although joint disease, as measured by the World Federation of Hemophilia (WFH) joint score, did not influence the association between haemophilia disease severity and BMI, adjustment for the atrophy component of the WFH score reduced the association between haemophilia severity and BMI by 39.1–69.9%. This suggested that muscle atrophy mediated at least part of the relationship between haemophilia severity and BMI. Haemophilia disease severity is associated with BMI and appears to be mediated by muscle atrophy of surrounding joints. This association appears to be modified by HIV status and possibly age.     

血清学指标和脂肪肝指数诊断非酒精性脂肪性肝病价值分析*

目的 探讨应血清指标和脂肪肝指数(FLI)诊断非酒精性脂肪性肝病(NAFLD)患者的价值。方法 2016年3月～2019年3月我院肝病科诊治的NAFLD 患者86例和同期进行体检的健康人群86例,检测血清胰脂肪酶(P-LIP)、降钙素原(PCT)、C反应蛋白(CRP),计算FLI。结果 NAFLD患者血清PCT和CRP水平及FLI分别为(0.10±0.05) μg/L、(5.6±1.0)μg/L和(37.4±3.6),显著高于健康人【分别为(0.04±0.02)μg/L、(2.8±0.7)μg/L和(18.2±1.3),P<0.05】,而血清P-LIP水平为(27.1±2.4)U/L,显著低于健康人【(35.8±3.2)U/L,P<0.05】;18例非酒精性脂肪肝肝炎(NASH)相关肝硬化患者血清PCT、CRP、P-LIP和FLI分别为(0.18±0.07)μg/L、(7.4±1.2)μg/L、(22.9±1.7)U/L和39.41±4.0,与33例NASH患者【分别为(0.11±0.04)μg/L、(4.8±0.5)μg/L、(27.7±2.2)U/L和(38.0±3.7)比或与35例单纯性脂肪肝患者【分别为(0.07±0.02)μg/L、(3.0±0.3)μg/L、(34.2±2.6)U/L和(35.8±3.4)比,差异显著(P<0.05);FLI诊断NAFLD的灵敏度和特异度分别为76.7%和73.3%,而FLI联合血清CRP、PCT和P-LIP诊断的灵敏度和特异度分别为66.3%和86.1%。结论 FLI诊断NAFLD患者具有一定的临床应用价值,联合其他一些血清指标可能有助于提高诊断效率。