Identification of independent risk factors for diabetic neuropathy progression in patients with type 2 diabetes mellitus

ObjectiveTo identify independent risk factors for diabetic neuropathy (DN) in patients with type 2 diabetes mellitus (T2DM).MethodsWe retrospectively analyzed 376 patients with T2DM at the First Affiliated Hospital of Fujian Medical University, China between January 2013 and October 2016. Multivariate logistic regression was used to explore potential risk factors for progression of DN in patients with T2DM. Effect sizes were estimated using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe prevalence of DN in patients with T2DM was 43.1%. Multivariate logistic regression indicated that retinopathy (OR: 2.755, 95% CI: 1.599–4.746); diabetic nephropathy (OR: 2.196, 95% CI: 1.279–3.772); longer duration of T2DM (OR: 1.081, 95% CI: 1.045–1.120); use of insulin (OR: 1.091, 95% CI: 1.018–1.170); longer history of alcohol consumption (OR: 1.034, 95% CI: 1.010–1.059); and higher blood urea nitrogen (OR: 1.081, 95% CI: 1.009–1.159) were associated with increased risk of DN in patients with T2DM.ConclusionsRetinopathy, diabetic nephropathy, longer duration of T2DM, use of insulin, longer history of alcohol consumption, and higher blood urea nitrogen were independent risk factors for DN. These findings should be verified in large-scale prospective studies.     

Associations of serum uric acid level with diabetic retinopathy and albuminuria in patients with type 2 diabetes mellitus

ObjectivesTo analyze the associations of serum uric acid (SUA) level with diabetic microvascular complications, including diabetic retinopathy (DR) and diabetic nephropathy (DN), in patients with type 2 diabetes mellitus (DM).MethodsThree hundred eighty-nine inpatients with type 2 DM were included in this retrospective analysis. Nonmydriatic fundus cameras were used to identify DR. Urinary albumin creatinine ratio was used to identify DN. Patients were divided into four groups according to SUA quartiles.ResultsThe prevalences of DR and albuminuria increased with increasing SUA level. Multivariate logistic regression analysis showed that, following adjustment for other risk factors, higher levels of SUA (Q3 and Q4) were associated with greater risk for DR, compared with the lower level (Q1) (odds ratio [OR]: 3.056, 95% confidence interval [CI]: 1.506–6.198; OR: 3.417, 95% CI: 1.635–7.139, respectively). Moreover, higher levels of SUA (Q2, Q3, and Q4) were associated with greater risk for albuminuria (OR: 2.418, 95% CI: 1.059–5.522; OR: 7.233, 95% CI: 3.145–16.635; and OR: 8.911, 95% CI: 3.755–21.147, respectively).ConclusionsSUA level was independently associated with DR and albuminuria in patients with type 2 DM. Elevated SUA level might be predictive for the occurrence of DR and DN.     

视网膜血管直径与2型糖尿病视网膜病变的关系

目的探讨视网膜微血管直径与2型糖尿病（DM2）并发症糖尿病视网膜病变（DR）的关系。方法选取2009年1月11月住院确诊DM2患者200例,根据眼底彩色照相结果将患者分为DR组和NDR组,测量视网膜血管直径、测定生化指标及血压,用非条件Logistic回归分析糖尿病视网膜病变发生的危险因素。结果 V1扩张10μm时,DM2患者并发DR危险性增加（OR1.75,95%CI1.14～3.04,P〈0.05）;空腹血糖水平增加1mmol/L,DM2患者并发DR的危险性增加（OR1.87,95%CI1.43～2.81,P〈0.05）;糖化血红蛋白增加1个单位,DM2患者并发DR的危险性增加（OR1.08,95%CI1.02～1.13,P〈0.05）;DM病程增加1年,DM2患者并发DR的危险性增加（OR1.41,95%CI1.18～1.70,P〈0.05）。结论在DM2患者中,视网膜静脉直径大小、空腹血糖水平、糖化血红蛋白水平、糖尿病病程是DR发生的危险因素。     

Type 2 diabetes mellitus increases liver transplant-free mortality in patients with cirrhosis: A systematic review and meta-analysis

BACKGROUNDThe impact of type 2 diabetes mellitus (T2DM) on the prognosis and complications of liver cirrhosis is not fully clarified. AIMTo clarify the mortality and related risk factors as well as complications in cirrhotic patients with T2DM.METHODSWe searched PubMed, EMBASE, and the Cochrane Library from their inception to December 1, 2020 for cohort studies comparing liver transplant-free mortality, hepatocellular carcinoma (HCC), ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy (HE) in cirrhotic patients with vs without T2DM. Odds ratios (ORs) were combined by using fixed-effects or random-effects models with RevMan software.RESULTSThe database search generated a total of 17 cohort studies that met the inclusion criteria. Among these studies, eight reported the risk of mortality, and eight reported the risk of HCC. Three studies provided SBP rates, and two documented ascites rates. Four articles focused on HE rates, and three focused on variceal bleeding rates. Meta-analysis indicated that T2DM was significantly associated with an increased risk of liver transplant-free mortality [OR: 1.28, 95% confidence intervals (CI): 1.16-1.41, P < 0.0001] and HCC incidence (OR: 1.82, 95%CI: 1.32-2.51, P = 0.003). The risk of SBP was not significantly increased (OR: 1.16 95%CI: 0.86-1.57, P = 0.34). Additionally, T2DM did not significantly increase HE (OR: 1.31 95%CI: 0.97-1.77, P = 0.08), ascites (OR: 1.11 95%CI: 0.84-1.46, P = 0.46), and variceal bleeding (OR: 1.34, 95%CI: 0.99-1.82, P = 0.06).CONCLUSIONThe findings suggest that cirrhotic patients with T2DM have a poor prognosis and high risk of HCC. T2DM may not be associated with an increased risk of SBP, variceal bleeding, ascites, or HE in cirrhotic patients with T2DM.     

Hyperinsulinemia cluster predicts the development of type 2 diabetes independently of family history of diabetes.

OBJECTIVE: The aim of this prospective study was to determine risk factor clusters predicting type 2 diabetes in subjects with and without family history of diabetes by applying factor analyses. RESEARCH DESIGN AND METHODS: The study population consisted of 309 siblings of diabetic (DM+) or nondiabetic (DM-) probands. Risk factors, including lipids, lipoproteins, blood pressure, and glucose tolerance status, were measured at the baseline study and 8 years later. RESULTS: Siblings in the DM+ group had a significantly higher risk of diabetes (odds ratio [OR] = 3.25; P = 0.002) than siblings in the DM- group. Altogether, factor analyses revealed four significant factors in both the DM+ and DM- groups (the percentage of cumulative variance explained 62-66%). Of these, factor 1 (percentage of variance, 27-29%) was characterized by high loadings for BMI, hypertension, glucose area, insulin area (the highest loading), and triglycerides in both the DM+ and DM- groups; therefore, factor 1 can be interpreted as a hyperinsulinemia factor. Also, other factors were essentially similar in both groups. Hyperinsulinemia factor was similarly associated with the risk of developing diabetes in the DM+ group (OR = 4.33, 95% CI 2.29-8.19; P < 0.001) and the DM- group (OR = 4.22, 95% CI 2.02-8.81; P < 0.001) in logistic regression analyses. CONCLUSIONS: Our results indicate that a cluster of cardiovascular risk factors around hyperinsulinemia is an important predictor of diabetes in 8-year follow-up independent of family history of diabetes.     

妊娠期糖尿病营养相关危险因素病例对照研究

目的:探讨妊娠期糖尿病（GDM）营养相关危险因素,为孕期合理膳食及健康管理提供依据。 目的　探讨妊娠糖尿病（gestational diabetes mellitus,GDM）营养相关危险因素,为孕期合理膳食及健康管理提供依据。方法　纳入2014年12月至2015年5月就诊于北京协和医院产科且在孕24~28周完成糖耐量筛查的25~45岁孕妇。采取多阶段连续等比例抽样,确诊GDM新发病例150例为病例组,同期就诊非GDM 150例为对照组。利用食物频率问卷对其一般情况及膳食状况进行调查。采用Logistic回归筛选GDM营养相关危险因素。结果　单因素分析显示,2型糖尿病家族史、孕前体重指数（body mass index, BMI）、GDM史、水果摄入量、精制谷物所占比例、每日肉类摄入量、高脂食品摄入频率、每日食盐摄入量、每日烹调油摄入量、每日坚果摄入量、在外就餐频率、含糖饮料摄入及体力活动状况与GDM之间相关性具有统计学意义（P＜0.05）。多因素Logistic回归分析显示,孕前BMI (OR=1.628, 95% CI: 1.079~2.456)、2型糖尿病家族史 (OR=1.761, 95% CI: 1.001~3.096)、GDM史(OR=7.855, 95% CI: 1.982~31.125)、水果摄入量(OR=1.457, 95% CI: 1.148~1.849)、精制谷物(OR=1.350, 95% CI:1.008~1.808)、高脂食品(OR=1.398, 95% CI: 1.066~1.833)及缺乏体力活动(OR=1.257, 95% CI: 1.111~1.422)与GDM具有相关性(P＜0.05)。结论　孕前BMI异常、2型糖尿病家族史、GDM史、水果摄入过量、主食过于精制、经常摄入高脂食品及缺乏体力活动可增加GDM发病风险。     

Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study

BACKGROUND: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m(-2) < BMI < or = 30 kg m(-2)) or obesity (BMI >30 kg m(-2)) and VTE risk has not been investigated. METHODS: We carried a multicenter case-control study of VTE among postmenopausal women aged 45-70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. RESULTS: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7-3.7] for overweight and 3.9 (95% CI: 2.2-6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6-7.7 and OR = 1.1; 95% CI: 0.7-1.7, respectively). Compared with non-users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5-30.2 and OR = 20.6; 95% CI: 4.8-88.1, respectively). However, transdermal users with increased BMI had similar risk as non-users with increased BMI (OR = 2.9; 95% CI: 1.5-5.8 and OR = 2.7; 95% CI: 1.7-4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1-14.1 and OR = 4.0; 95% CI: 2.1-7.8 respectively for obesity). CONCLUSIONS: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.     

The Leu72Met polymorphism of the ghrelin gene is associated with a decreased risk for type 2 diabetes

BACKGROUND: Ghrelin is involved in several metabolic and cardiovascular processes. The Leu72Met polymorphism of its gene was associated with an increased risk of type 2 diabetes (DM2) in some, but not all studies. Its association with atherosclerosis is not known. METHODS: We investigated 420 Caucasian subjects with DM2 and 430 controls without diabetes (56.6% male, age 62+/-10 years). RESULTS: The Leu72Leu genotype frequencies were 89.76/84.65%, the Leu72Met 9.52/15.12% and the Met72Met 0.71/0.23% (P=0.029) in the DM2 and controls groups, respectively. In subjects with Met72+ genotypes the risk of DM2 was significantly decreased (univariate OR 0.63, 95% CI 0.42-0.95, P=0.026). In a logistic regression model, body mass index, hypertension and a positive family history for diabetes were predictors of diabetes while the polymorphism remained negatively associated with the disease (OR 0.62, 95% CI 0.40-0.97, P=0.036). After adjusting for known risk factors for atherosclerosis, the Met72+ variant was not associated with atherosclerotic disease (OR 1.41, 95% CI 0.78-2.54, P=0.25). Ghrelin concentrations were not associated with the polymorphism, DM2 or atherosclerotic disease. CONCLUSIONS: The Leu72Met polymorphism of the ghrelin gene is associated with a decreased risk for DM2. There is no association between the variant and atherosclerotic disease or ghrelin concentrations.     

Factors associated with the use of pharmacologic agents to facilitate out-of-hospital endotracheal intubation

Objective

To identify a set of clinical factors most strongly associated with the use of drug-facilitated intubation (DFI) in the out-of-hospital setting.

Method

The authors used data from a prospective, multicentered endotracheal intubation (ETI) observational cohort trial, including patients from 45 emergency medical services in Pennsylvania. Providers reported clinical, physiologic, and anatomic factors associated with each ETI effort. The authors included only data from the 23 services using DFI. They identified all non-arrest (presence of a pulse) adult patients. They included both successful and failed ETIs. They defined DFI cases as patients who received a sedative or neuromuscular-blocking agent to facilitate ETI. The authors also classified patients who underwent nasotracheal intubation as DFI. They defined control subjects as patients undergoing conventional oral ETI. They performed multivariate logistic regression to identify the clinical, physiologic, and anatomic factors characteristic of DFI. They examined alternate forms of the final prediction model.

Results

The authors analyzed data from 208 nonarrest patients, including 92 DFIs and 116 control subjects. Of 34 factors potentially related to DFI, 17 were excluded on univariate analysis (likelihood ratio p > 0.25). Multivariate logistic regression revealed the following as positively associated with DFI: presence of clenched jaw/trismus (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.10-4.95; p = 0.026); increased verbal Glasgow Coma Scale score (OR, 1.71; 95% CI, 1.29-2.26; p<0.001); use of cervical spine precautions (OR, 2.30; 95% CI, 1.15-4.62; p = 0.018). Anterior vocal cords (OR, 0.27; 95% CI, 0.10-0.71; p = 0.004) and laryngospasm (OR, 0.14; 95% CI, 0.02-1.17; p = 0.025) were negatively associated with DFI. The model showed good fit (Hosmer-Lemeshow p = 0.75) and discrimination (area under the curve = 0.76).

Conclusions

The authors identified a set of predictors strongly associated with DFI. These data offer insight into the current use of DFI and support the development of consensus-based guidelines for this procedure.     

Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations

BACKGROUNDThe Black/African Ancestry (AA) population has a higher prevalence of type 2 diabetes mellitus (T2DM) and a higher incidence and mortality rate for colorectal cancer (CRC) than all other races in the United States. T2DM has been shown to increase adenoma risk in predominantly white/European ancestry (EA) populations, but the effect of T2DM on adenoma risk in Black/AA individuals is less clear. We hypothesize that T2DM has a significant effect on adenoma risk in a predominantly Black/AA population.AIMTo investigate the effect of T2DM and race on the adenoma detection rate (ADR) in screening colonoscopies in two disparate populations.METHODSA retrospective cohort study was conducted on ADR during index screening colonoscopies (age 45-75) performed at an urban public hospital serving a predominantly Black/AA population (92%) (2017-2018, n = 1606). Clinical metadata collected included basic demographics, insurance, body mass index (BMI), family history of CRC, smoking, diabetes diagnosis, and aspirin use. This dataset was combined with a recently reported parallel retrospective cohort data set collected at a suburban university hospital serving a predominantly White/EA population (87%) (2012-2015, n = 2882).RESULTSThe ADR was higher in T2DM patients than in patients without T2DM or prediabetes (35.2% vs 27.9%, P = 0.0166, n = 981) at the urban public hospital. Multivariable analysis of the combined datasets showed that T2DM [odds ratio (OR) = 1.29, 95% confidence interval (CI): 1.08-1.55, P = 0.0049], smoking (current vs never OR = 1.47, 95%CI: 1.18-1.82, current vs past OR = 1.32, 95%CI: 1.02-1.70, P = 0.0026), older age (OR = 1.05 per year, 95%CI: 1.04-1.06, P < 0.0001), higher BMI (OR = 1.02 per unit, 95%CI: 1.01-1.03, P = 0.0003), and male sex (OR = 1.87, 95%CI: 1.62-2.15, P < 0.0001) were associated with increased ADR in the combined datasets, but race, aspirin use and insurance were not.CONCLUSIONT2DM, but not race, is significantly associated with increased ADR on index screening colonoscopy while controlling for other factors.     

Risk factors for postoperative nosocomial infections in the department of otorhinolaryngology北大核心CSCD

Objective To analyze the risk factors for postoperative nosocomial infections in the department of otorhinolaryngology, and provide guidance on improving the quality of life for patients. Methods The clinical data of the patients undergoing surgical procedure in the department of otorhinolaryngology form January 2011 to December 2016 were reviewed to identify the potential risk factors of nosocomial infections. Chi-square test and multivariate logistic regression model were used for the analysis. Results A total of 152 (2.25%) cases of nosocomial infection were identified in 6 753 cases of surgical operation. Univariate analysis revealed that sex, age, length of stay, patient referral, class of surgical wounds, length of operation, and complications were related to postoperative nosocomial infections. The patients without nosocomial infection showed higher cure rate than those complicated with nosocomial infection (P<0.05). Multivariate logistic regression analysis identified that male (OR=2.831, 95% CI: 1.758-4.558), older (OR=5.833, 95% CI: 4.491-7.577), patient referral (OR=1.790, 95% CI: 1.008-3.178), higher class of surgical wound contamination (OR=34.866 for Class I, OR=2 120.995 for Class II, and OR=43 917.453 for Class III wounds), and longer length of operation (OR=9.384, 95% CI: 18.168-47.525) were the independent risk factors for postoperative nosocomial infections in the department of otorhinolaryngology. Conclusions Multiple risk factors are associated with postoperative nosocomial infections in the department of otorhinolaryngology. Integrated measures must be taken for prevention and control of nosocomial infections based on the specific conditions of the patient. © 2018, Editorial Department of Chinese Journal of Infection. All rights reserved.     

Genetic association of interleukin-1beta (-511C/T) and interleukin-1 receptor antagonist (86 bp repeat) polymorphisms with Type 2 diabetes mellitus in North Indians

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with a subclinical systemic inflammation and development of complications like nephropathy, retinopathy, neuropathy and hypertension. We studied the genetic association of bi-allelic polymorphism (-511C/T) of interleukin (IL)-1beta and 86 bp variable number tandem repeat (VNTR) polymorphism of natural receptor antagonist (IL-1RN) with T2DM and associated complications in North Indians. METHODS: We genotyped 200 patients with T2DM and 223 healthy control subjects for IL-1beta (-511C/T) by PCR-RFLP. Genotyping of IL-1RN (VNTR) polymorphism was determined by gel electrophoresis after PCR amplification. RESULTS: Interleukin-1beta (-511C/T) and IL-1RN (VNTR) polymorphisms were significantly associated with T2DM. IL-1beta -511T, IL-1RN*2 and IL-1RN*3 alleles were associated with high risk of T2DM whereas; individuals with IL-1beta -511C and IL-1RN*1 alleles were at low risk. Haplotype frequency analysis showed that T2 (IL-1beta -511T/IL-1RN*2) haplotype was associated with the high risk (p=0.000; OR=2.4, 95% CI 1.68-3.34) and C1 (IL-1beta -511C/IL-1RN*1) haplotype showed low risk (p=0.000; OR=0.38, 95% CI 0.27-0.53). Further, CT, TT genotypes of IL-1beta (-511C/T) and 1/2 genotype of IL-1RN (VNTR) were found to be associated with risk of complications particularly with nephropathy in T2DM. CONCLUSION: The IL-1beta (-511C/T) and IL-1RN (VNTR) polymorphisms are significantly associated with increased risk of T2DM as well as associated complications in North Indians.     

2011-2020年青海省学生肺结核患者就诊延迟及影响因素分析

目的 分析青海省学生肺结核患者就诊延迟现状及影响因素,为学生结核病防控工作提供参考依据。方法 青海省2011—2020年学生肺结核患者信息来源于全国结核病管理信息系统,采用SPSS 19.0软件进行χ²检验、趋势χ²检验,采用多因素logistic回归分析学生肺结核患者就诊延迟影响因素。结果 青海省2011—2020年学生肺结核患者共4 496例,就诊延迟2 168例,就诊延迟率为48.22%,就诊天数中位数为14 d(P25,P75:2, 36 d)。2011—2020年学生肺结核患者就诊延迟率呈下降趋势(趋势χ²=360.186,P<0.01)。多因素logistic回归分析结果显示,藏族(OR=0.636, 95%CI:0.511～0.791)和患者来源中的其他健康检查患者(OR=0.667, 95%CI:0.483～0.914)发生就诊延迟风险较低;而患者来源中的因症推荐(OR=3.565, 95%CI:2.275～5.774)、转诊(OR=2.363, 95%CI:1.849～3.037)和追踪(OR=1...     

Foot ulcer risk is lower in South-Asian and african-Caribbean compared with European diabetic patients in the U.K.: the North-West diabetes foot care study

OBJECTIVE: To determine 1) foot ulcer rates for European, South-Asian, and African-Caribbean diabetic patients in the U.K and 2) the contribution of neuropathy and peripheral arterial disease (PAD) differences to altered ulcer risk between the groups. RESEARCH DESIGN AND METHODS: In this U.K. population-based study, we screened 15,692 type 1 and type 2 diabetic patients in the community health care setting for foot ulcers, foot deformities, neuropathy, and PAD plus other characteristics. In total, 13,409 were European (85.5%), 1,866 were South Asian (11.9%), and 371 were African Caribbean (2.4%). RESULTS: The age-adjusted prevalence of diabetic foot ulcers (past or present) for Europeans, South Asians, and African Caribbeans was 5.5, 1.8, and 2.7%, respectively (P < 0.0001). Asians and African Caribbeans had less neuropathy, PAD, and foot deformities than Europeans (P = 0.003). The unadjusted risk of ulcer (odds ratio [OR]) for Asians versus Europeans was 0.29 (95% CI 0.20-0.41) (P < 0.0001). PAD, neuropathy, foot deformities, and insulin use attenuated the age-adjusted OR from 0.32 to 0.52 (0.35-0.76) (P < 0.0001). African-Caribbean versus European ulcer risk in males was attenuated from 0.60 to 0.71 by vibration sensation. CONCLUSIONS: South Asians with diabetes in the U.K. have about one-third the risk of foot ulcers of Europeans. The lower levels of PAD, neuropathy, insulin usage, and foot deformities of the Asians account for approximately half of this reduced foot ulcer risk. Lower neuropathy is the main contributor to the reduced African-Caribbean ulcer rate, particularly in men. The reasons for these ethnic differences warrant further investigation.     

2型糖尿病合并非酒精性脂肪性肝病肝纤维化与骨密度的相关性

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)肝纤维化与骨密度的关系。方法:筛选T2DM患者539例,依据腹部超声分为T2DM组(n=234)、T2DM+NAFLD组(n=305),再依据非酒精性脂肪肝肝纤维化评分(non-alcoholic fatty liver disease fibrosis score,NAFLDFS)分为<-1.455排除纤维化亚组、-1.455~0.676可疑纤维化亚组、>0.676诊断纤维化亚组,行骨密度检查并测定空腹血糖(fasting blood glucose,FBG)、空腹C肽(fasting C-peptide,F-CP)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(HbA1c)、肝功能及血脂等血清学指标。结果:与T2DM组相比,T2DM+NAFLD组股骨颈、Ward’s三角、大粗隆、股骨干及全部股骨的骨密度及T值下降(P<0.05)。与-1.455~0.676亚组及<-1.455亚组相比,>0.676亚组股骨颈、Ward’s三角的骨密度及T值下降(P<0.05)。T2DM组和T2DM+NAFLD组骨量异常(骨量减少和骨质疏松)发生率存在差异(48.29%vs 65.90%,P<0.01);<-1.455亚组,-1.455~0.676亚组,>0.676亚组骨量异常发生率存在差异(48.39%vs 67.98%vs 82.5%,两两比较均P<0.01)。相关性分析示:NAFLDFS与股骨颈、Ward’s三角的骨密度及T值呈负相关(P<0.05)。Logistic回归分析示:在控制年龄、性别、BMI、病程、FBG、ALT、HDLC、HbA1C及载脂蛋白B(APOB)后,NAFLDFS评分是骨量减少的独立危险因素。-1.455~0.676亚组相对于<-1.455亚组骨量减少的风险增加(OR=2.235,95%CI 1.040~4.803,P<0.05);>0.676亚组相对于<-1.455亚组骨量减少的风险增加(OR=4.463,95%CI 1.221~16.308,P<0.05)。结论:T2DM合并NAFLD肝纤维化患者骨密度减低,两者具有相关性,进展性肝纤维化是骨量减少的危险因素。     

Risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-beta-lactamase in two tertiary-care teaching hospitals

OBJECTIVES: To assess risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-beta-lactamase (MBL-PA) in two teaching hospitals where horizontal dissemination has been demonstrated. METHODS: A case-control study was performed in both hospitals (assigned as hospital 1 and 2). Cases were patients with MBL-PA infections and controls were those with non-MBL-PA infections. Multivariate analysis was performed to identify independent risk factors. RESULTS: A total of 86 cases and 212 controls were included in the study. A logistic regression model showed that exposure to beta-lactams [odds ratio (OR) 3.21; 95% confidence interval (CI) 1.74-5.93] or fluoroquinolones (OR 3.50; 95% CI 1.46-8.37) was associated with MBL-PA infections. Other independent risk factors were neurological disease (OR 3.00; 95% CI 1.61-5.58), urinary tract infection (OR 2.48; 95% CI 1.21-5.09) and renal failure (OR 2.29; 95% CI 1.13-4.65). Admission to hospital 1 (OR 5.97; 95% CI 3.45-14.09) and intensive care unit stay (OR 2.07; 95% CI 1.46-3.96) were also associated with increased risk for MBL-PA infections. CONCLUSIONS: beta-Lactam exposure is an important risk factor for MBL-PA infections even in a setting where patient-to-patient transmission plays a major role in the spread of the isolates. Other risk factors deserve further investigation, particularly exposure to fluoroquinolones.     

Temporal trends in prevalence of diabetes mellitus in a population-based cohort of incident myocardial infarction and impact of diabetes on survival

OBJECTIVE: To determine the temporal trends in prevalence of confirmed diabetes mellitus (DM), time from the date DM criteria were met to myocardial infarction (MI), and impact of DM on survival. SUBJECTS AND METHODS: A retrospective cohort design was used to identify residents of Olmsted County, Minnesota, with incident MI from 1979 to 1998. The MI cases were characterized according to prevalent DM. Cases with and without DM were followed up for vital status until January 1, 2003. RESULTS: Of 2171 MI cases, 364 (17%) met criteria for prevalent DM. In the age- and sex-adjusted logistic regression models, the odds of prevalent DM Increased 3% with each Increasing year between 1979 and 1998 (95% confidence Interval [CI], 1%-5%; P=.007). Survival for MI cases with DM was unchanged between 1979-1983 and 1994-1998 (P=.74). For all MI cases, age-, sex-, and DM-adjusted risk of death decreased 3% from 1979 to 1998 (95% CI, 1%-5%) per year for 28-day survival (P=.02) and 2% (95% CI, 1%-3%) per year for 5-year survival (P=.02). There was a significant adverse effect of DM on 5-year survival after MI (age-, sex-, and calendar year-adjusted hazard ratio, 1.70; 95% CI, 1.38-2.09; P<.001). The adverse effect of DM persisted after adjusting for other cardiovascular disease risk factors, MI severity, and reperfusion therapy (hazard ratio, 1.66; 95% CI, 1.34-2.05; P<.001) and was unchanged over time (interaction between DM and calendar year, P=-.63). CONCLUSION: These data indicate that the prevalence of DM among patients with MI is increasing and that its adverse impact on survival after MI remains unchanged.     

Risk factors and outcomes associated with vancomycin-resistant Enterococcus infections with reduced susceptibilities to linezolid

A retrospective matched case-control study of hospitalized patients with vancomycin-resistant Enterococcus (VRE) infection with reduced susceptibility to linezolid was performed in order to identify risk factors for this infection and describe patient outcomes. Forty-eight linezolid nonsusceptible VRE cases were identified between January 1, 2000, and September 30, 2008, and compared to 96 controls with linezolid-susceptible VRE, matched based on culture date and anatomic site of infection. Demographic, clinical and microbiological data were collected. On univariable analysis, risk factors for reduced linezolid susceptibility included allogeneic hematopoietic stem cell transplant and/or solid organ transplant (odds ratio [OR]: 2.63; 95% confidence interval [CI]: 1.13-6.15; P = 0.025), receipt of immunosuppressive medications (OR: 2.39; 95% CI: 1.08-5.29; P = 0.032) including corticosteroids (OR: 2.40; 95% CI: 1.03-5.58; P = 0.042) and noncorticosteroid immunosuppressives (OR: 2.31; 95% CI: 1.00-5.30; P = 0.049), and receipt of linezolid within 1 year prior to infection (OR: 34.50, 95% CI: 4.60-259.02; P < 0.001). On multivariable analysis, only receipt of linezolid within 1 year remained an independent risk factor for reduced linezolid susceptibility (OR: 31.84; 95% CI: 4.20-241.39; P < 0.001), although most patients with VRE with reduced linezolid susceptibility had not received linezolid in the year prior. Reduced linezolid susceptibility did not impact patient outcomes including clinical or microbiological cure, hospital length of stay, or all-cause mortality.     

Determinants of transfusion-associated bacterial contamination: results of the French Bacthem Case-Control Study

BACKGROUND: Transfusion-associated bacterial contamination (TABC), probably the most frequent transfusion-transmitted infection, may induce serious adverse events. Systematic information and documentation on determinants are lacking. STUDY DESIGN AND METHODS: The BACTHEM Study is a French matched case-control study assessing TABC determinants. Included were cases of TABC reported in France in a 2-year period, as determined from uniform definitions. Information on recipient-, blood component-, and donor-related potential determinants was collected on site. ORs were estimated by conditional logistic regression. RESULTS: Of the 158 cases of suspected TABC reported, 41 that involved transfusion with 25 RBCs and 16 platelet concentrates were included. Gram-negative rods accounted for nearly half of the bacteria species involved and for all six deaths. In comparison with the risk of TABC for patients receiving RBCs for anemia, the risk was higher for patients receiving RBCs for pancytopenia (OR, 7.3; 95% CI, 1.3-41.0) and for those receiving platelets for thrombocytopenia (OR, 5.3; 95% CI, 1.2-24.1). Other potential determinants were platelet transfusion for pancytopenia (OR, 4.5; 95% CI, 0.5-40.0), immunosuppressive treatment (OR, 2.8; 95% CI, 0.7-10.6), shelf-life of more than 1 day for platelets or 8 days for RBCs (OR, 2.6; 95% CI, 0.7-9.6), and more than 20 previous donations by donors (OR, 1.9; 95% CI, 0.7-5.3). CONCLUSION: This first comparative study revealed TABC determinants that suggest approaches for prevention.