Diabetes is associated with high risk of severe adverse events during chemotherapy for cancer patients: A single-center study

Diabetes mellitus (DM) is a common comorbidity among cancer patients, but its impact on chemotherapy tolerance has not been widely studied. We aimed to compare the occurrence of severe grade 3/4 adverse events (G3/4 AEs) within 90 days of starting chemotherapy between patients with and without diabetes. We conducted a retrospective single-center study in Lille University Hospital Oncology Department, France. Patients who received the first cycle of chemotherapy for gastrointestinal, gynecological or cancer of unknown primary source between 1 May 2013 and 1 May 2016, were included. Overall, 609 patients were enrolled: 490 patients without diabetes (80.5%) and 119 patients with diabetes (19.5%). Within 90 days of starting chemotherapy, patients with diabetes had a significantly higher occurrence of AEs G3/4 compared to those with no diabetes (multivariate odds ratio [OR]: 1.57 [1.02-2.42], P = .04). More frequent G3/4 AEs in patients with diabetes were infection (26%), hematological disorders (13%), endocrine disorders (13%) and deterioration of the general condition (13%). In the year following the beginning of chemotherapy, patients with diabetes were twice as likely to be hospitalized as those without diabetes (univariate OR: 2.1 [1.40-3.15], P = .0003). After multivariate adjustment, diabetes was no longer significantly associated with the risk of hospitalization (P = .051). There were no differences between patients with and without diabetes regarding dose reduction and chemotherapy treatment delays (P = .61 and P = .30, respectively). Our study suggests the need for better consideration of DM in the personalized care plan to improve chemotherapy tolerance and quality of life of patients with DM.     

糖尿病肾病患者认知功能障碍与血清β淀粉样蛋白的关系

目的 探讨糖尿病肾病(diabetic kidney disease,DKD)患者认知功能障碍与人β淀粉样蛋白1-42(human β Amyloid 1-42,Aβ1-42)的关系。方法 选取2020年5月至2021年5月在徐州医科大学附属医院内分泌科治疗的2型糖尿病(type 2 diabetes mellitus,T2DM)患者161例,根据尿白蛋白/肌酐比值(urine albumin creatine ratio,UACR)水平分为正常白蛋白尿(DM)组(n=60)、微量白蛋白尿(DKD1)组(n=58)和大量白蛋白尿(DKD2)组(n=43)。采用蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评估患者认知功能。检测患者Aβ1-42、UACR、胱抑素C(Cystatin C,CysC)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR),并分析上述指标与MoCA评分的关系。结果 与DM组比较,DKD1和DKD2组CysC、Aβ1-42均升高(P<0.05),eGFR降低(P<0.05)。与DKD1组比较,DKD2组CysC升高(P<0.05),eGFR降低(P<0.05)。与DM组相比,DKD1组、DKD2组MoCA评分均降低(P<0.05)。与DKD1组比较,DKD2组MoCA评分降低(P<0.05)。3组MoCA评分与Aβ1-42、UACR、CysC呈负相关(均P<0.01),与eGFR呈正相关(P<0.01)。3组Aβ1-42与UACR、CysC呈正相关(均P<0.01),与eGFR呈负相关(P<0.01)。多因素线性回归分析结果显示,Aβ1-42、UACR是影响DKD患者MoCA评分的影响因素,Aβ1-42、UACR水平越高,MoCA评分越低,患者认知功能越差。结论 DKD患者存在认知功能障碍,与Aβ1-42水平及肾损害严重程度密切相关。     

Correlation analysis of intestinal flora and pathological process of type 2 diabetes mellitus

ObjectiveTo observe the relationship between the different stages of type 2 diabetes mellitus (T2DM) and the intestinal flora and verify its underlying mechanism.MethodsT2DM rats were generated by high-fat diet (HFD) combined with intraperitoneal streptozotocin (STZ) injection. The rats were divided into four groups: the control group (fed with normal feed for 1 month), the HFD group (fed with HFD for 1 month), the T2DM group (HFD combined with STZ and blood glucose ≥11.1 mM), and the unformed T2DM model (Un-mod) group (HFD combined with STZ and blood glucose <11.1 mM). Feces were collected, and bacterial communities in the fecal samples were analyzed by 16S rRNA gene sequencing. The content of short-chain fatty acids (SCFAs) in feces was measured by gas chromatography. Western blot and quantitative real-time polymerase chain reaction were used to detect the expression of G protein-coupled receptor 41 (GPR41) and GPR43.ResultsAt different stages of T2DM, the intestinal flora and SCFAs content of rats were significantly decreased (all P < .05). Our results indicated that g__Prevotella had a significant negative correlation, and g__Ruminococcus_torques_group and g__lachnoclastic had a significant positive correlation with blood glucose. The content of SCFAs, in particular acetate and butyrate, in rat feces of different stages of T2DM were significantly reduced, as well as GPR41 and GPR43 expression. The results in the Un-mod group were similar to the T2DM group, and the expression of GPR41 and GPR43 proteins were significantly higher than those in the T2DM group (both P < .001).ConclusionThe intestinal flora–SCFAs–GPR41/GPR43 network may be important in the development of T2DM. Decreasing blood glucose levels by regulating the intestinal flora may become a new therapeutic strategy for T2DM, which has very important clinical and social values.     

Perioperative,short-, and long-term outcomes of gastric cancer surgery: Propensity score-matched analysis of patients with or without prior solid organ transplantation

BackgroundDetails of perioperative outcomes and survival after gastric cancer surgery in prior transplant recipients have received minimal research attention.MethodsWe performed an observational cohort study using the database of 20,147 gastric cancer patients who underwent gastrectomy at a single gastric cancer center in Korea. Forty-one solid organ recipients [kidney (n = 35), liver (n = 5), or heart (n = 1)] were matched with 205 controls using propensity score matching.ResultsOperation time, blood loss, and postoperative pain were similar between groups. Short-term complication rates were similar between transplantation and control groups (22.0% vs. 20.1%, P = 0.777). Transplantation group patients with stage 1 gastric cancer experienced no recurrence, while those with stage 2/3 cancer had significantly higher recurrence risk compared to the controls (P = 0.049). For patients with stage 1 cancer, the transplantation group had a significantly higher rate of non-gastric cancer-related deaths compared to the controls (19.2% vs. 1.4%, P = 0.001). For those with stage 2/3 cancer, significantly lower proportion of the transplantation group received adjuvant chemotherapy compared to the control group (26.7% vs. 80.3%, P < 0.001). The transplantation group had a higher (albeit not statistically significant) rate of gastric cancer-related deaths compared to the controls (40.0% vs. 18.0%, P = 0.087).ConclusionTransplant recipients and non-transplant recipients exhibited similar perioperative and short-term outcomes after gastric cancer surgery. From long-term outcome analyses, we suggest active surveillance for non-gastric cancer-related deaths in patients with early gastric cancer, as well as strict oncologic care in patients with advanced cancer, as effective strategies for transplant recipients.     

妊娠期糖尿病中胎盘外泌体对滋养细胞增殖、细胞周期及凋亡的影响*

目的：探讨妊娠期糖尿病（GDM）中胎盘外泌体对滋养细胞增殖、细胞周期及细胞凋亡的影响。方法： 选取2018 年3 月至2019 年4 月间重庆市第七人民医院50 例诊断为GDM患者（GDM组），另选取50 例正常孕产 妇作为对照组。分离纯化GDM组和对照组孕产妇外周血血浆中的胎盘外泌体，通过透射电镜观察外泌体的形 态，纳米粒径分析检测外泌体的直径，免疫印迹检测外泌体标志性蛋白CD63、TSG101 及胎盘标志性分子胎盘 碱性磷酸酶（PLAP）的表达。PKH67染色后荧光共聚焦显微镜观察体外培养滋养细胞系对外泌体的摄取情况； 应用MTT实验检测外泌体对滋养细胞增殖能力的影响，流式细胞术检测外泌体对滋养细胞周期的影响，Annexin V-FITC/PI 双染色结合流式细胞术检测外泌体对滋养细胞凋亡的影响。结果：成功从外周血中分离获得了胎盘外 泌体，形态呈典型的杯状或双凹状，直径为40 ～ 120 nm，CD63、TSG101、PLAP 表达呈阳性；与对照组相比， GDM组胎盘外泌体以浓度依赖性促进滋养细胞的增殖、细胞周期进展，并抑制滋养细胞的凋亡。结论：GDM中 胎盘外泌体可能通过促进滋养细胞的增殖、细胞周期进展，抑制滋养细胞凋亡等参与GDM的发生和发展。     

2型糖尿病患者饮食决策平衡与大五人格特征的相关性研究

目的探讨2型糖尿病患者饮食决策平衡现状及其与大五人格特征的相关性,以期为临床个体化健康饮食教育提供参考。方法便利抽样法选取重庆市3所三级甲等医院内分泌科住院的192例2型糖尿病患者为研究对象,采用饮食决策平衡量表和大五人格量表简化版(neuroticism extraversion openness five factor inventory,NEO-FFI)对其进行调查。结果2型糖尿病患者知觉利益得分为22.00(20.00,24.00)分,知觉障碍得分为20.50(16.00,23.00)分,饮食决策平衡得分为2.00(-3.00,8.00)分;饮食决策平衡与大五人格中的宜人性和严谨性呈正相关,与神经质呈负相关(均P<0.05)。结论2型糖尿病患者饮食决策平衡水平较低,与其人格特征密切相关。护理人员应有针对性地帮助患者采取有效的应对措施,以促进其饮食决策平衡水平的提高。     

Management of Type 2 Diabetes: Current Strategies,Unfocussed Aspects,Challenges, and Alternatives

Type 2 diabetes mellitus (T2DM) accounts for >90% of the cases of diabetes in adults. Resistance to insulin action is the major cause that leads to chronic hyperglycemia in diabetic patients. T2DM is the consequence of activation of multiple pathways and factors involved in insulin resistance and β-cell dysfunction. Also, the etiology of T2DM involves the complex interplay between genetics and environmental factors. This interplay can be governed efficiently by lifestyle modifications to achieve better management of diabetes. The present review aims at discussing the major factors involved in the development of T2DM that remain unfocussed during the anti-diabetic therapy. The review also focuses on lifestyle modifications that are warranted for the successful management of T2DM. In addition, it attempts to explain flaws in current strategies to combat diabetes. The employability of phytoconstituents as multitargeting molecules and their potential use as effective therapeutic adjuvants to first line hypoglycemic agents to prevent side effects caused by the synthetic drugs are also discussed.