High‐normal urinary albumin‐to‐creatinine ratio is independently associated with metabolic syndrome in Chinese patients with type 2 diabetes mellitus: A cross‐sectional community‐based study

Aims/Introduction

Microalbuminuria is positively related to metabolic syndrome (MetS). Our aim was to investigate whether urinary albumin-to-creatinine ratio (UACR) within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes.

Materials and Methods

A total of 514 participants (206 males and 308 females; mean age 66 years) with UACR less than 3.5 mg/mmol were enrolled from two downtown areas of Shanghai. The participants were stratified into quartiles according to UACR levels. The prevalence of MetS was assessed and compared among the four groups by binary logistic regression.

Results

Compared with participants with UACRs in the first quartile, the other quartiles had a higher prevalence of MetS (65.9%, 74.4% and 81.3%, respectively, P = 0.001) after adjustment for sex and age. After adjusting for potential confounders, participants in the second to the fourth quartile group had a 1.36-, 1.84- and 2.73-fold risk of MetS, respectively, relative to those in the lowest quartile. Furthermore, UACR, whether as quartile groups or as a continuous variable, is an independent predictor of MetS after fully adjusting for other variables.

Conclusions

These results suggest that UACR even within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes mellitus.     

Molecular and histological effects of MR-guided pulsed focused ultrasound to the rat heart

Background

Image-guided high intensity focused ultrasound has been used as an extracorporeal cardiac pacing tool and to enhance homing of stem cells to targeted tissues. However, molecular changes in the myocardium after sonication have not been widely investigated. Magnetic-resonance (MR)-guided pulsed focused ultrasound (pFUS) was targeted to the rat myocardium over a range of pressures and the microenvironmental and histological effects were evaluated over time.

Methods

Eight-to-ten-week-old Sprague–Dawley rats received T2-weighted MR images to target pFUS to the left ventricular and septum without cardiac or respiratory gating. Rats were sonicated through the thoracic wall at peak negative pressures (PNP) from 1 to 8 MPa at a center frequency of 1 MHz, 10 ms pulse duration and 1 Hz pulse repetition frequency for 100 pulses per focal target. Following pFUS, myocardium was harvested over 24 h and subjected to imaging, proteomic, and histological measurements.

Results

pFUS to the myocardium increased expression of cytokines, chemokines, and trophic factors characterized by an initial increase in tumor necrosis factor (TNF)-α followed by increases in pro- and anti-inflammatory factors that returned to baseline by 24 h. Immediately after pFUS, there was a transient (< 1 h) increase in N-terminal pro b-type natriuretic peptide (NT-proBNP) without elevation of other cardiac injury markers. A relationship between PNP and expression of TNF-α and NT-proBNP was observed with significant changes (p < 0.05 ANOVA) ≥ 4 MPa compared to untreated controls. Contrast-enhanced ex vivo T1-weighted MRI revealed vascular leakage in sonicated myocardium that was accompanied by the presence of albumin upon immunohistochemistry. Histology revealed infiltration of neutrophils and macrophages without morphological myofibril changes in sonicated tissue accompanied by pulmonary hemorrhage at PNP > 4 MPa.

Conclusions

MR-guided pFUS to myocardium induced transient proteomic and histological changes. The temporal proteomic changes in the myocardium indicate a short-lived sterile inflammatory response consistent with ischemia or contusion. Further study of myocardial function and strain is needed to determine if pFUS could be developed as an experimental model of cardiac injury and chest trauma.

     

Axillary nerve course and position in the fetal period: An anatomic dissection study for surgical practice

Objectives:

To examine the fetal axillary nerve to reveal and compare its morphometric features within the second and third trimester.

Methods:

This study was conducted at the Anatomy Department, School of Medicine, Mersin University, Mersin, Turkey. Thirty-five fetal shoulders were studied to provide anatomic data and to describe its position with regard to certain landmarks around the shoulder.

Results:

The shortest distance between the axillary nerve and the glenoid labrum was found 2.27 mm and 2.89 mm in the second and third trimester fetuses, respectively. The shortest distances between the anterior and posterior acromial tips and the axillary nerve were also measured and were used with arm length measurements to define the anterior and posterior indexes.

Conclusion:

The indexes show that the distance between the axillary nerve and the anterior/posterior acromial tips are approximately one-fourth of the arm length in both the second and third trimester fetuses. The data presented in this study will be of use to surgeons, particularly to pediatric and orthopedic surgeons who will undertake surgical procedures in the axilla and arm in the newborn or early childhood.There is detailed knowledge regarding the morphological features of the axillary nerve in adults, however, it in the fetal period we encountered no information. Brachial plexus injuries have been reported with a rate of 0.38-2.6 per thousand live births. Shenaq et al1 mentioned that the diagnosis, observation, and therapy are the initial approaches to these injuries, and should be initiated immediately. They also stated that early surgical intervention is essential to maximizing the long-term improvements in selected patients by helping to prevent residual growth deformities and underdevelopment of the affected limbs. The surgical treatment options include the reconstruction and neurotization.2 For the axillary nerve injuries, for example in case of C5-C6 avulsion, in which the upper roots have been avulsed from the spinal cord, and the clinical picture is that of a classic Erb palsy, they preferred to use neurotization technique. In this type of avulsion, the upper roots are not available as donors, and the C7-T1 roots are uninvolved. So, the suprascapular nerve is neurotized by the ipsilateral spinal accessory nerve, and the axillary nerve is neurotized by redundant branches to the triceps to ideally restore shoulder and elbow function. The thoracodorsal or the subscapular branches can also be neurotized to the axillary nerve to provide better shoulder function. Thus, anatomical details of the axillary nerve in fetal period become essential for such operations. We carried out this study to evaluate these parameters regarding the axillary nerve anatomy, which may be helpful to surgeons in certain conditions, such as end-to-side neurorrhaphy in brachial plexus reconstruction, neurotization, proximal humeral fracture repair, and shoulder dislocation treatment in the early childhood.