非空腹血脂与动脉粥样硬化性心血管疾病发生及预后关系的研究进展

动脉粥样硬化性心血管疾病(ASCVD)是危害人类健康最主要的慢性非传染性疾病之一,尽管既往大量研究表明空腹血脂与ASCVD发生及其预后密切相关,但空腹血脂检测在临床上有一定的局限性。近年来研究发现,非空腹血脂对ASCVD的发生及预后也有重要作用,且相比空腹血脂,非空腹血脂检测能反映人体一天中大部分时间的血脂水平,更方便快捷。因此,本文就非空腹血脂的定义、优缺点、使用范围及其与ASCVD发生及预后关系的研究进展、致动脉粥样硬化的可能机制进行综述,以期为临床实践提供指导。     

Butanol fraction of Khaya senegalensis root modulates β-cell function and ameliorates diabetes-related biochemical parameters in a type 2 diabetes rat model

Ethnopharmacological relevance

Khaya senegalensis A. Juss (Meliaceae) is commonly exploited for the traditional treatment of diabetes mellitus in Nigeria and Togo. The present study was conducted to examine the anti-diabetic activity of Khaya senegalensis butanol fraction (KSBF) of root ethanolic extract in a type 2 diabetes (T2D) model of rats.

Materials and methods

T2D was induced in rats by feeding a 10% fructose solution ad libitum for two weeks followed by a single intraperitoneal injection of streptozotocin (40 mg/kg body weight) and the animals were treated with 150 and 300 mg/kg body weight (BW) of the fraction for five days in a week. Relevant diabetes-related parameters were analyzed in all experimental animals.

Results

The KSBF treatment, at 300 mg/kg BW, significantly (p<0.05) reduced blood glucose level, improved oral glucose tolerance ability and β-cell function (HOMA-β), decreased insulin resistance (HOMA-IR), stimulated hepatic glycogen synthesis, ameliorated serum lipids alterations and prevented hepatic and renal damages compared to untreated diabetic rats. Additionally, the fraction insignificantly (p>0.05) improved weight gain, decreased food and fluid intake, stimulated insulin secretion and lowered serum fructosamine concentrations compared to untreated diabetic rats.

Conclusions

Data from this study suggests that orally administered KSBF, at 300 mg/kg BW, possess remarkable anti-type 2 diabetic activity and could ameliorate some diabetes-associated complications and hence can be considered as a source of potential anti-type 2 diabetic medicine.     

Higher Non-fasting Serum Triglyceride Preceding the Carotid Stenosis Progression

The present study was conducted to investigate whether non-fasting serum triglyceride (TG) levels can be used to assess a risk for the progression of carotid artery stenosis. This was a single- center retrospective study. Consecutive 96 patients with ≥50% stenosis of at least unilateral cervical internal carotid artery and normal fasting serum low-density lipoprotein cholesterol (LDL-C) levels of ≤140 mg/dL were followed up for at least 1 year (mean, 3.1 years), and clinical variables were compared between patients with and without carotid stenosis progression (≥10% increases in the degree on ultrasonography). Carotid stenosis progression was shown in 21 patients, associated with less frequent treatment with calcium channel blockers (CCBs), higher non-fasting TG and glucose levels. In carotid artery-based analyses including <50% stenosis side, stenosis progression was shown in 23 of 121 arteries except for those with complete occlusion and less than 1-year follow-up period because of carotid artery stenting (CAS) or carotid endarterectomy (CEA). Stenosis progression was more frequently observed in symptomatic and/or radiation-induced lesions, and was also accompanied with less frequent treatment with CCBs, higher non-fasting TG and glucose levels in carotid artery-based analyses. The receiver operating characteristic (ROC) curve analyses revealed that a cutoff value of non-fasting TG to discriminate carotid stenosis progression was 169.5 mg/dL for carotid arteries with the baseline stenosis of <50%, and 154.5mg/dL for those of ≥50%. Non-fasting TG level was an independent risk factor of carotid stenosis progression, and more strict control of non-fasting TG may be necessary for higher degree of carotid artery stenosis.     

Discovery of a Potent Thiadiazole Class of Histamine H3 Receptor Antagonist for the Treatment of Diabetes

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Anti-diabetic effects of the acetone fraction of Senna singueana stem bark in a type 2 diabetes rat model

Ethnopharmacological relevance

Senna singueana is currently used in the traditional treatment of diabetes mellitus in Nigeria. The present study examined the anti-diabetic activity of the Senna singueana acetone fraction (SSAF) of stem bark in a type 2 diabetes (T2D) rat model.

Materials and methods

Crude ethyl acetate extract of the Senna singueana stem bark was fractionated with various solvents and the acetone fraction was selected for in vivo studies based on the high α-glucosidase and α-amylase inhibitory activities. In the in vivo study, male Sprague-Dawley rats were induced with T2D and treated with the SSAF at 150 and 300 mg/kg body weight. Several T2D-related parameters were measured in the study.

Results

After 4 weeks of intervention, non-fasting blood glucose concentrations were significantly decreased and the glucose tolerance ability was significantly improved in the SSAF treated groups compared to the diabetic control group. Serum insulin concentrations, pancreatic β-cell function (HOMA-β) and liver glycogen were significantly (P<0.05) increased while serum alanine transaminase, alkaline phosphatase and urea were significantly decreased in the SSAF treated diabetic rats compared to the diabetic control group. Though insignificantly (P>0.05), other T2D-induced abnormalities such as food and fluid intake, body weight, serum lipids, serum fructosamine level and peripheral insulin resistance (HOMA-IR) were also partially ameliorated by the SSAF treatment.

Conclusion

Data of this study suggest that orally administered SSAF could ameliorate most of the T2D-induced abnormalities in a T2D model of rats.     

Emergency Medicine Resident Performed Bedside Ultrasonography of the Gallbladder in Non-Fasted Healthy Volunteers

Background: Gallbladder ultrasonography is a commonly performed test in the emergency department. It is unknown whether a non-fasting state alters the visualization of the gallbladder by emergency medicine (EM) residents. Objectives: We conducted this study to determine whether EM residents are able to visualize the gallbladder in volunteers who have recently consumed a fatty meal. Methods: This study used a prospective, single-blinded, randomized controlled design. Initial scans were performed on fasting volunteers. A fatty meal was then consumed. Thirty minutes after eating, a different resident, who was unaware of whether the volunteer had eaten or fasted, performed a second scan. To control for operator bias, 10% of subjects remained fasting between scans. Student's paired-samples t-test, Pearson's chi-squared, and McNemar test were determined as appropriate. Results: A total of 92 scans from 46 volunteers were analyzed. EM residents were able to visualize the gallbladder in all 40 pre-prandial scans (100%) and all 40 post-prandial scans (100%). Gallbladder area as measured in the longitudinal axis decreased 20% from a mean baseline of 11.58 ± 4.86 cm² (95% confidence interval [CI] 11.17–12.98) to 9.2 ± 5.04 cm² (95% CI 7.74–10.66, p = 0.0009) after food intake. Total time to scan for the fasting volunteers (110.2 s, 95% CI 84.34–136) did not change significantly from non-fasting volunteers (129.7 s, 95% CI 110.29–149.01, p = 0.153). Conclusions: EM residents are able to visualize the gallbladder in non-fasted healthy volunteers.     

13C]-urea breath test without prior fasting and without test meal is accurate for the detection of Helicobacter pylori infection in Chinese

BACKGROUND AND AIM: Conventional [13C]-urea breath test ([13C]-UBT) requires prior fasting and a test meal, which theoretically improves the accuracy of the test. However, recent studies have suggested that prior fasting and test meal may not be essential. We aimed to determine the accuracy of a new [13C]-UBT protocol without fasting in Chinese. METHODS: Dyspeptic patients referred for upper endoscopy were recruited. The gold standard for Helicobacter pylori infection was the combination of Campylobacter-like organism (CLO) test and histology. Group I (n = 213) patients underwent [13C]-UBT with prior fasting and with citrate acid test meal. Group II (n = 123) patients underwent [13C]-UBT without prior fasting but with test meal. Group III (n = 90) patients underwent [13C]-UBT without prior fasting and without test meal. RESULTS: The highest accuracy for groups I, II and III was 96.7, 95.1 and 95.5% using a cut-off value of 5.0, 5.5 and 3.5, respectively. The sensitivities and specificities were 97.4 and 95.8% in group I, 93.3 and 96.8% in group II, and 96.5 and 93.9% in group III, respectively. CONCLUSION: The [13C]-UBT protocols without prior fasting and either with or without test meal produce highly accurate and reliable results in the Chinese population.     

非空腹甘油三酯与急性脑梗死预后的关系

目的:探讨血浆非空腹甘油三酯水平(TG)对急性脑梗死患者预后的影响。方法:回顾性收集急性脑梗死患者446例,记录其入院时血压、血糖、美国国立卫生研究院卒中量表(NIHSS)评分、血浆甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平。改良Rankin量表(mRS)评估患者3月时的预后,并对影响患者预后的危险因素进行多因素Logistic回归分析。结果:与预后良好组相比,预后不良组的患者年龄、BMI更大,基线NHISS评分、基线空腹血糖更高,冠心病、心房颤动患病率更高,非空腹TG水平较低(P<0.05)。单因素回归分析显示,年龄、BMI、吸烟、冠心病、房颤、基线空腹血糖、基线NIHSS评分和血浆非空腹TG水平是影响脑梗死预后的因素(P<0.05)。多因素回归分析显示,高非空腹TG水平(OR=0.548,95%CI 0.372～0.808,P=0.002)是脑梗死良好结局的预测因子。非空腹TG水平预测患者良好结局的ROC曲线下面积为0.669(95%CI 0.618～0.702,P=0.000),其预测临界值为非空腹TG 1.455 mmol/L时,敏感度为67.9%,特异度为61.8%。结论:急性脑梗死患者发病时非空腹TG水平是90 d良好结局的独立预测因素。