Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events

BACKGROUND: Elevated troponin I has been associated with increased mortality in critically ill patients without acute coronary syndrome (ACS). However, the prognostic significance of troponin elevation in patients with diabetic ketoacidosis (DKA) without evident ACS has not been studied. METHODS: Retrospective study of all patients admitted to a U.S. tertiary center between 01/98 and 12/00 with DKA and had troponin I level measured. Patients with evidence of ACS or who met the American College of Cardiology/European Society of Cardiology (ACC/ESC) definition for myocardial infarction were excluded. Baseline characteristics, cardiac evaluation and 2 year major adverse coronary event (MACE) rate were compared between patients with positive and negative troponin. RESULTS: Ninety-six patients fulfilled the inclusion criteria of this study, 26 had positive troponin. There were no differences in baseline characteristics between the two groups. After a 2 year follow-up, there was significantly increased mortality in patients with elevated troponin (50.0% versus 27.1%, hazard-ratio (HR) 2.3, 95% confidence interval (CI) 1.2-4.8, p = 0.02). Patients with elevated troponin also had significantly increased MACE rate at 2 years (50.0% versus 28.6%, HR 2.6, 95% CI 1.3-5.3, p = 0.007) driven primarily by mortality. Using Cox Proportional Hazard Analysis, elevated troponin was a predictor of increased MACE after adjusting for confounding variables. (Adjusted HR 2.3, 95% CI 1.1-4.6, p = 0.02) CONCLUSIONS: Elevated troponin I in diabetic patients admitted with DKA identifies a group at very high risk for future cardiac events and mortality. Whether cardiac risk stratification of these patients will improve long term outcome remains to be studied.     

Prevalence of double diabetes in youth onset diabetes patients from east Delhi and neighboring NCR region

Background

It is being increasingly reported that some of the youth onset diabetes patients cannot be classified clearly as type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on usual criteria and the term double diabetes (DD) coined for these cases.

丁螺环酮与帕罗西汀联合治疗抑郁症的临床研究

目的探讨丁螺环酮与帕罗西汀联合治疗抑郁症的疗效。方法符合ICD-10或CCMD-3抑郁症诊断标准的门诊和住院病人79例，随机分成两组，分别用丁螺环酮联合帕罗西汀和单用帕罗西汀治疗6周，采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评定疗效，用副反应量表（TESS）评定副反应。结果6周末联合组HAMD和HAMA评分低于单用组。在第2周末、第6周末联合组的HAMD和HAMA的平均减分率高于单用组。两组间的副反应情况相仿。结论丁螺环酮联合帕罗西汀治疗抑郁症的疗效优于单用帕罗西汀。     

The effects of glucose-dependent insulinotropic polypeptide infused at physiological concentrations in normal subjects and Type 2 (non-insulin-dependent) diabetic patients on glucose tolerance and B-cell secretion

Summary The effects of porcine glucose-dependent insulinotropic polypeptide given by continuous intravenous infusion in normal subjects (n=6) and Type 2 (non-insulin-dependent) diabetic patients (n=6) have been investigated. The subjects were studied on 2 separate days after overnight fasts. On each day 25 g of glucose was infused from 0–30 min plus an infusion of either porcine glucose-dependent insulinotropic polypeptide (0.75 pmol·kg^–1·min^–1) or control solution. During the glucose-dependent insulinotropic polypeptide infusion plasma glucose values were reduced in normal subjects from 30–60 min (p<0.01) and in Type 2 diabetic patients at 45 and 60 min (p<0.05). In the normal subjects insulin concentrations were greater from 10–35 min (p<0.01) following glucose-dependent insulinotropic polypeptide infusion and peak values were increased by 123%. In the Type 2 diabetic patients following glucose-dependent insulinotropic polypeptide infusion insulin levels were increased from 4–40 min (p<0.01) but peak values were only increased by 27%. In the normal subjects C-peptide values were greater from 25–45 min (p<0.01) following glucose-dependent insulinotropic polypeptide infusion and peak C-peptide levels were increased by 82%. In the Type 2 diabetic patients following the glucose-dependent insulinotropic polypeptide infusion C-peptide levels were increased from 6–55 min (p<0.01) and peak values were increased by 20%. Plasma glucose-dependent insulinotropic polypeptide levels were within the physiological post prandial range during the glucose-dependent insulinotropic polypeptide infusion. Glucose-dependent insulinotropic polypeptide is insulinotropic in normal subjects and Type 2 diabetic patients at physiological concentrations and results in improved glucose tolerance. This insulinotropic effect is less marked in the diabetic patients and may represent insensitivity of the B cell to glucose-dependent insulinotropic polypeptide.     

芪丹通络颗粒联合硫辛酸治疗糖尿病周围神经病变的临床研究

目的探讨芪丹通络颗粒联合硫辛酸注射液治疗糖尿病周围神经病变的临床疗效。方法选取2015年5月-2018年5月在成都市青白江区人民医院治疗的86例糖尿病周围神经病变患者,根据用药差别分为对照组(43例)和治疗组(43例)。对照组静脉滴注硫辛酸注射液,12 mL加入生理盐水250 mL,2次/d;治疗组在对照组的基础上口服芪丹通络颗粒,8 g/次,3次/d。两组患者均经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者MDNS和TCSS评分,神经传导速度,及血清同型半胱氨酸(Hcy)、核因子-κB(NF-κB)、内皮素-1(ET-1)和一氧化氮(NO)水平。结果治疗后,对照组临床有效率为62.79%,显著低于治疗组的86.05%,两组比较差异有统计学意义(P<0.05)。经治疗,两组MDNS评分、TCSS评分均明显降低(P<0.05),且治疗组下降更明显(P<0.05)。经治疗,两组患者正中神经和腓总神经的运动神经传导速(MNCV)、感觉神经传导速度(SNCV)均明显增快(P<0.05),且治疗组传导速度明显快于对照组(P<0.05)。经治疗,两组患者血清Hcy、NF-κB、ET-1水平均明显降低(P<0.05),NO水平明显升高(P<0.05),且治疗组患者血清Hcy、NF-κB、ET-1和NO水平明显好于对照组(P<0.05)。结论芪丹通络颗粒联合硫辛酸注射液治疗糖尿病周围神经病变可有效改善患者症状,促进神经功能恢复,具有一定的临床推广应用价值。     

肾康栓联合贝那普利治疗糖尿病肾病的临床研究

目的探讨肾康栓联合盐酸贝那普利片治疗糖尿病肾病的临床疗效。方法选取2018年4月—2020年3月天津中医药大学第一附属医院收治的86例糖尿病肾病患者为研究对象,根据随机数字表法将所有患者分为对照组和治疗组,每组各43例。对照组口服盐酸贝那普利片,10 mg/次,1次/d。治疗组在对照组治疗的基础上给予肾康栓,每日早中晚各1粒,睡前2粒。两组在治疗8周后统计疗效。观察两组的临床疗效,比较两组肾功能指标[白蛋白排泄率(UAER)、尿微量白蛋白、血清胱抑素C(Cys-C)]和细胞因子[内皮素-1(ET-1)、单核细胞趋化因子-1(MCP-1)、降钙素基因相关肽(CGRP)]水平。结果治疗后,治疗组的总有效率(93.02%)高于对照组(79.07%),差异有统计学意义(P0.05)。治疗后,两组的UAER、尿微量白蛋白、Cys-C水平均显著低于治疗前(P0.05);治疗后,治疗组的UAER、尿微量白蛋白、Cys-C水平比对照组低(P0.05)。治疗后,两组的ET-1、MCP-1水平显著降低,CGRP水平显著升高(P0.05);治疗后,治疗组患者的ET-1、MCP-1水平比对照组低,CGRP水平比对照组高(P0.05)。结论肾康栓联合盐酸贝那普利片治疗糖尿病肾病的疗效确切,可改善肾功能,调节血清细胞因子水平,安全性良好,具有良好的临床价值。     

Contribution of Alcohol and Nicotine Dependence to the Prevalence of Depressed Mood in Different Ethnic Groups in The Netherlands: The HELIUS Study

Abstract

Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.

Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N?=?22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).

Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.

Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.     

PTA联合NPWT治疗缺血性糖尿病足溃疡的疗效分析

目的探讨经皮腔内血管成形术(PTA)联合负压伤口疗法(NPWT)治疗缺血性糖尿病足溃疡的临床效果。方法64例缺血性糖尿病足溃疡患者,依据治疗方法不同分为NPWT组和PTA联合NPWT组,每组32例。NPWT组患者采用NPWT治疗,PTA联合NPWT组患者采用PTA联合NPWT治疗。比较两组治疗前后踝肱指数、伤口愈合时间、保足率。结果PTA术后足部皮肤温度升高,血液供应明显改善,足背动脉搏动增强。术后患肢CT血管造影(CTA)图像见:患肢动脉狭窄闭塞动脉开通,远端可见足背血管显影。坏死趾节截趾清创NPWT治疗后创面肉芽生长良好。植皮治疗后伤口愈合良好。治疗前,两组患者踝肱指数比较差异无统计学意义(P>0.05);PTA合并NPWT组患者治疗2周后踝肱指数(0.52±0.19)、保足率93.8%均高于NPWT组的(0.44±0.08)、75.0%,差异具有统计学意义(P<0.05);两组患者创面愈合时间比较差异无统计学意义(P>0.05)。结论PTA联合NPWT治疗缺血性糖尿病足溃疡的疗效优于单独应用NPWT治疗,可提高保足率。     

《内经》五郁之治在儿科临床中的应用

《内经》五郁之治,是针对五气太过而致五脏气郁所提出的治疗法则,从五郁治法概述以及相应木郁达之、火郁发之、土郁夺之、金郁泄之、水郁折之五法进行了理论阐释和临床运用举例。指出五郁之治不仅适用于内科常见病证的辨治,对于儿科临床常见病证的辨治亦有很好的指导意义。     

Correlation between the platelet‐to‐lymphocyte ratio and diabetic foot ulcer in patients with type 2 diabetes mellitus

ObjectiveTo investigate the correlation between the platelet‐to‐lymphocyte ratio (PLR) and diabetic foot ulcer (DFU) in patients with type 2 diabetes mellitus (T2DM).MethodFrom January 2018 to August 2019, 206 patients with T2DM admitted to the Central Hospital of Wuhan, China, were enrolled in this study, including 104 patients with DFU (DFU group) and 102 patients without DFU (T2DM group). During the same period, 90 healthy subjects were randomly screened as normal controls (NC group). The correlation between PLR and DFU in patients with T2DM was explored by comparing the PLR of the subjects in the three groups.ResultsThe PLRs of the DFU and T2DM groups were higher than that of the NC group, whereas the PLR of the DFU group was higher than that of the T2DM group (p < 0.05). PLR was positively correlated with the Wagner DFU grade (p < 0.001). Based on logistic regression analysis, PLR was found to be an independent risk factor for DFU (OR =1.029, 95% CI: 1.019 ~ 1.039, p < 0.001). The receiver operating characteristic curve analysis of the PLR showed that the area under the curve of the PLR for predicting diabetic foot ulcer was 0.776 (p < 0.001), and the analysis determined that the optimal critical value of the PLR for predicting DFU was 147.6.ConclusionThe PLR is significantly elevated in patients with DFU and positively correlated with the Wagner DFU grade, which might be a valuable marker for early diagnosis and assessment of severity of DFU.