A short message service (SMS) intervention to prevent diabetes in Chinese professional drivers with pre-diabetes: A pilot single-blinded randomized controlled trial

Aim

To determine the efficacy of delivering short-message service (SMS) to provide diabetes-related information in reducing the risk of developing diabetes in Chinese professional drivers with pre-diabetes.

Methods

A pilot single-blinded randomized controlled trial was conducted in Hong Kong between 05/2009 and 04/2012. Professional drivers with impaired glucose tolerance (IGT) were randomly allocated to either a SMS group receiving messages comprising knowledge and lifestyle modification on diabetes or to a control group with usual care. Primary outcomes were the incidence rate of diabetes mellitus over 12 and 24 months period.

Results

Fifty-four, out of 104 professional drivers recruited, were randomly allocated to intervention group. Fewer subjects developed diabetes at 12 months in intervention group (5.56%) compared to control group (16.00%). Relative risk (RR) of diabetes onset was 0.35 (95%CI: 0.10–1.24) and the number needed to treat (NNT) for preventing one diabetes was 9.57. At 24 months, RR increased to 0.62 (95%CI: 0.24–1.61) with a NNT of 10.58. Logistic regression showed a significant odds ratio of 0.04 (P = 0.021) for intervention group compared to control group at 12-month follow-up for completers and a non-significant odds ratio of 0.34 (P = 0.303) at 24-month follow-up.

Conclusions

The SMS program proved to have potential to reduce the risk of developing diabetes at 12 months but additional measures should be integrated to prevent or delay disease progression.     

A Method to Estimate the Efficacy vs. Effectiveness in Meta-Analysis of Clinical Trials with Different Adherence Scenarios: A Monte Carlo Simulation Study in Nutrition

Randomized clinical trials (RCTs) evaluating the effectiveness of interventions to promote fruit and vegetable (FV) consumption usually report intention-to-treat (ITT) analysis as the main outcome. These analyses compare the randomly assigned groups and accept that some individuals may not follow the recommendations received in their group. The ITT analysis is useful to quantify the global effect of promoting the consumption of FV in a population (effectiveness) but, if non-adherence is significant in the RCT, they cannot estimate the specific effect in the individuals that increased their FV consumption (efficacy). To calculate the efficacy of FV consumption, a per protocol analysis (PP) would have to be carried out, in which groups of individuals are compared according to their actual adherence to FV consumption, regardless of the group to which they were assigned; unfortunately, many RCTs do not report the PP analysis. The objective of this article is to apply a new method to estimate the efficacy of Meta-analysis (MA) PP which include RCTs of effectiveness by ITT, without estimates of adherence. The method is based on generating Monte Carlo simulations of percentages of adherence in each allocation group from prior distributions informed by expert knowledge. We illustrate the method reanalyzing a Cochrane Systematic Review (SR) of RCTs on increased FV consumption reported with ITT, simulating 1000 times the estimation of a PP meta-analyses, and obtaining means and ranges of the potential PP effects. In some cases, the range of estimated PP effects was clearly more favourable than the effect calculated with the original ITT assumption, and therefore this corrected analysis must be considered when estimating the true effect of the consumption of a certain food.     

Ischemia-modified albumin,a predictive marker of major adverse cardiovascular events in continuous ambulatory peritoneal dialysis patients

Objectives

The aim of this study was to evaluate the efficiency of ischemia-modified albumin (IMA) for predicting major adverse cardiovascular events (MACE) in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design and methods

A prospective observational study was conducted with 120 CAPD patients and 37 healthy volunteers. Demographic and clinical data were collected. The primary end point is the occurrence of MACE.

Results

A total of 157 participants with a mean age of 43.64 years finally completed this study. The CAPD patients had a significantly high rate of MACE (P = 0.001) and high levels of IMA than healthy controls (P < 0.001). Compared with CAPD patients with normal levels of IMA, the CAPD patients with high levels of IMA (> 85 kU/L) had lower non-MACE survival rate (P < 0.001), which indicated that the high IMA CAPD patients may suffer a high rate of MACE. In addition, the high IMA CAPD patients also had a low level of serum albumin (P < 0.001) and hemoglobin (P = 0.018). The correlation analysis showed that the serum albumin level was the most effective factor influencing IMA (B = − 0.967, P < 0.001).

Conclusions

CAPD patients with high levels of IMA had a high incidence rate of MACE. IMA was a good predictive marker of MACE and might be important in cardiovascular risk stratification of CAPD patients.     

Impact of mercury exposure on blood pressure and cardiac autonomic activity among Cree adults (James Bay, Quebec, Canada)

Aboriginal populations from Quebec (Canada) are exposed to higher mercury levels than southern regions since these populations consume high quantities of fish. Epidemiological evidence suggests a detrimental impact of mercury on cardiovascular risk factors such as heart rate variability (HRV) and blood pressure (BP). The objective of this study was to assess the impact of mercury exposure on BP, resting heart rate (HR) and HRV among Cree adults. Data were collected among 791 adults ≥18 years old living in seven communities of the James Bay. Blood mercury and hair levels were used as biomarkers of recent and long-term exposure. BP was measured through a standardised protocol while HRV was derived from a 2-h Holter monitoring assessment. The relationship between mercury and the outcomes was studied using ANOVA and ANCOVA analysis. Geometric mean of blood mercury and hair mercury concentration was 17.0 nmol/L (95%CI: 6.1–44.0) and 2.36 nmol/g (95%CI: 2.09–2.65); respectively. After adjusting for confounders, blood mercury was associated with HRV parameters such as LF (β=0.21, P=0.0002), HF (β=0.15, P=0.004) and LF/HF (β=0.06, P=0.003). Similar associations were observed with hair mercury. In contrast, no significant association was observed between blood mercury or hair mercury and BP after adjusting for confounders. In conclusion, mercury exposure seems to affect HRV among Cree adults even after considering fish nutrients (n-3 fatty acids and selenium) and other contaminants (lead and polychlorinated biphenyls) that are also present in the traditional diet of this population.     

Diabetes and impaired glucose tolerance among Turkish immigrants in Sweden

Aim

To investigate whether the prevalence of diabetes and impaired glucose tolerance (IGT) was higher among Turkish immigrants in Sweden, than in their area of origin in Turkey.

Methods

238 Turkish immigrants aged 20 years and older living in Flemingsberg, Sweden, were compared with 1549 participants of the same age living in the Konya area of Turkey. Data collection included anthropometric measurements, blood pressure (BP) measurements, and an oral glucose tolerance test (OGTT).

Results

Prevalence of laboratory-verified diabetes was 11.8% among participants in Sweden compared to 7.1% among participants in Turkey (p 0.018). Turkish women in Sweden had a higher prevalence of diabetes than Turkish women in Turkey, 12.8% vs. 7.6% (p = 0.037). Similarly, IGT was 17.8% among Turkish men in Sweden compared to 4.9% among men in Turkey (p < 0.001) and 2-h blood glucose was higher among the immigrants (p < 0.001). Systolic BP was also higher among the immigrants, especially in men (p < 0.001) who also had a higher BMI (p = 0.003).

Conclusions

The higher prevalence of diabetes and IGT among Turkish immigrants in Flemingsberg, Sweden, suggests that migration is associated with diabetes and that there are important implications for public health in Sweden.     

The emerging evidence for vitamin D-mediated regulation of apolipoprotein A-I synthesis

Ischemic heart disease and cerebrovascular ischemia are leading causes of mortality in industrialized countries. The pathogenesis of these diseases involves the formation of atherosclerotic plaques with eventual rupture and superimposed thrombosis. This process is inhibited by high-density lipoprotein (HDL), the main protein component of which is apolipoprotein A-I (apo A-I). Vitamin D₃ is a hormone produced by sun-exposed skin but is acquired also in the diet. The Framingham Offspring Study and the Third National Health and Nutritional Examination Survey showed a link between vitamin D₃ intake and cardiovascular risk factors. The link between 25-hydroxyvitamin D₃ and HDL cholesterol (HDLc) and apo A-I is not as clear. Studies in vitamin D receptor knockout mice demonstrated higher HDLc and hepatic apo A-I messenger RNA expression relative to wild type. Experiments in cultured hepatocytes supported these observations. Human studies evaluating the relationship between vitamin D₃ and apo A-I and HDLc have yielded conflicting results, but most suggest a positive link between increasing vitamin D₃ levels and plasma apo A-I and HDLc. The purpose of this review is to examine the evidence linking vitamin D status and cardiovascular disease, to determine if there is a relationship between vitamin D levels and development of an atherogenic lipid profile. Our objectives are to determine if plasma vitamin D levels correlate with plasma HDLc and apo A-I and, if so, offer speculation as to how apo A-I in the context of high vitamin D levels provides enhanced atheroprotection.     

甜叶菊浸膏对抑郁小鼠脾脏组织中DBP和SP蛋白表达的影响

目的 探讨甜叶菊浸膏的抗抑郁活性及其对脾脏和大脑皮层组织中白蛋白启动子D位点结合蛋白(DBP)与P物质(SP)蛋白表达的影响.方法 将60只BALB/c ♂小鼠随机均分为对照组、模型组、阳性对照组、甜叶菊浸膏低剂量组(SEL,1.5 g·kg-1)和高剂量组(SEH,3 g·kg-1).用皮质酮悬液按20 mg· kg-剂量连续于腹腔注射21 d,复制小鼠抑郁模型,每天给药1次.待造模成功后,通过ig途径给予药物治疗.正常对照组和模型组继续给予生理盐水,阳性对照组给予氟西汀(30 mg·kg-1),甜叶菊浸膏各组给予相应剂量的药物,连续给药7d,每天给药1次.用旷场法测定各组小鼠的平行移动格数和直立次数等行为学指标;用Western Blot技术测定小鼠脾脏与大脑皮质中DBP和SP蛋白的表达.结果 模型组小鼠的平行移动格数和直立次数明显减少,与对照组的比较有显著性差异(P＜0.01),提示模型建立成功.给予甜叶菊浸膏后,可剂量依赖性地增加抑郁小鼠的平行移动格数(SEL:54.17±13.33,SEH:73.17±13.90)和直立次数(SEL:35.42 ±5.12,SEH:54.83±11.60),与模型组的比较有显著性差异(移动格数:20.08±3.53,直立次数:9.33 ±1.83);甜叶菊浸膏显著地增加了脾脏和脑组织中SP蛋白的表达水平,与模型组的比较有显著性差异(P ＜0.05,P＜0.01);甜叶菊浸膏减少了脾脏组织中DBP蛋白的表达,却增加了脑组织中DBP蛋白的水平,与模型组的比较有显著性差异(P＜0.01).结论甜叶菊浸膏可有效改善小鼠的抑郁症状,其抗抑郁机制可能与调控大脑皮层和脾脏组织中DBP及SP蛋白的表达水平有关.     

氨氯地平在健康人体内的药动学和药效学

目的:研究苯磺酸氨氯地平片在健康人体的药动学,及血药浓度与降血压效应的关系。方法:24名健康受试者单次口服10 mg苯磺酸氨氯地平片,服药后不同时间采集血样,采用LC-MS-MS法测定血浆中氨氯地平浓度,采用坐位动脉收缩压(SBP)和舒张压(DBP)的变化值为降压药效指标。结果:氨氯地平体内代谢呈二室模型,消除半衰期约36 h,表观分布容积较大,提示为全身分布,峰浓度约为(6.1±1.5)ng.mL-1。动脉收缩压和舒张压在用药后呈波动性下降,用药10 h后药效逐渐消失,可见一个药效滞后环。AUC0-120 h(ng.h.mL-1)和AUEC0-48(mmHg.h-1)分别为(237.1±77.2)和(126.1±49.8)(SBP)、(192.6±47.7)(DBP);Cmax(ng.mL-1)和Emax(mmHg)分别为(6.1±1.5)和(6.3±3.2)(SBP)、(10.1±2.9)(DBP);tmax(h)和TEmax(h)分别为(3.9±0.7)和(8.1±2.3)(SBP)、(9.2±1.2)(DBP)。结论:苯磺酸氨氯地平对动脉收缩压和舒张压均有降低作用,药效达峰时间在给药后6～10 h,均...     

Effects of dibutyl phthalate in male rabbits following in utero, adolescent, or postpubertal exposure.

We evaluated sequelae in male rabbits following exposure to dibutyl phthalate (DBP) at a dose level known to adversely affect testicular function in rodents without causing systemic toxicity. Because rabbits have a relatively long phase of reproductive development simulating better than rodents the reproductive development of humans, and because the use of rabbits facilitates multiple evaluations of mating ability and seminal quality, we used this animal model. Rabbits were exposed to 0 or 400 mg DBP/kg/day in utero (gestation days [GD] 15-29) or during adolescence (postnatal weeks [PNW] 4-12), and male offspring were examined at 6, 12, and 25 weeks of age. Another group was exposed after puberty (for 12 weeks) and examined at the conclusion of exposure. The most pronounced reproductive effects were in male rabbits exposed in utero. Male offspring in this group exhibited reduction in numbers of ejaculated sperm (down 43%; p < 0.01), in weights of testes (at 12 weeks, down 23%; p < 0.05) and in accessory sex glands (at 12 and 25 weeks, down 36%; p < 0.01 and down 27%; p < 0.05, respectively). Serum testosterone levels were down (at 6 weeks, 32%; p < 0.05); a slight increase in histological alterations of the testis (p < 0.05) and a doubling in the percentage (from 16 to 30%, p < 0.01) of abnormal sperm; and 1/17 males manifesting hypospadias, hypoplastic prostate, and cryptorchid testes with carcinoma in situ-like cells. In the DBP group exposed during adolescence, basal serum testosterone levels were reduced at 6 weeks (p < 0.01) while at 12 weeks, testosterone production in vivo failed to respond normally to a GnRH challenge (p < 0.01). In addition, weight of accessory sex glands was reduced at 12 weeks but not at 25 weeks after a recovery period; there was a slight increase in the percentage of abnormal sperm in the ejaculate; and 1/11 males was unilaterally cryptorchid. In both of these DBP-treated groups, daily sperm production, epididymal sperm counts, mating ability, and weights of body and nonreproductive organs were unaffected. Thus, DBP induces lesions in the reproductive system of the rabbit, with the intrauterine period being the most sensitive stage of life.