Effects of a nurse led web-based transitional care program on the glycemic control and quality of life post hospital discharge in patients with type 2 diabetes: A randomized controlled trial.

BACKGROUND: Individuals with type 2 diabetes have a heightened risk of developing serious complications post hospital discharge. Web-based transitional care is a promising intervention to improve the glycemic control and quality of life of this patient group; however, whether web-based transitional care can improve the glycemic control and quality of life of this group remains unknown. Further, the mechanisms underlying the relationships between the intervention and both glycemic control and quality of life have not been fully explored. OBJECTIVES: The aims of this study were to develop a web-based transitional care program and evaluate its effects on the glycemic control and quality of life of Chinese patients with type 2 diabetes and to explore the mediating roles of self-efficacy and treatment adherence. DESIGN: Randomized controlled trial. SETTINGS AND PARTICIPANTS: This study was conducted in a large regional hospital in Guangzhou City, China. Patients diagnosed with type 2 diabetes were included. METHODS: A total of 116 eligible participants were randomly assigned to receive either the 3-month web-based transitional care program or usual care. Assessments of hemoglobin A1c (HbA1c), self-efficacy, treatment adherence, and quality of life were conducted at baseline and at 3 months. Analysis followed the intention-to-treat principle. A generalized estimating equation was used to determine intervention effects on HbA1c and quality of life. Path analysis was used to assess the mediation of these effects by changes in self-efficacy and treatment adherence during the intervention. RESULTS: Participants in the intervention group had significantly greater improvements in HbA1c (ß = 2.87; p < 0.01) and quality of life (ß = 7.69; p < 0.01) compared with the control group. The relationships between the intervention and both glycemic control and quality of life were significantly mediated by improved self-efficacy (indirect effect: ß = 0.18, p < 0.05) and improved treatment adherence (indirect effect: ß = 0.17, p < 0.05); overall, the model explained 52.5% of the variance in HbA1c and 34.2% of the variance in quality of life. CONCLUSIONS: Our study identified beneficial effects of a web-based transitional care program on glycemic control and quality of life post hospital discharge in people with type 2 diabetes, and the underlying mediating mechanisms. The effectiveness and feasibility of this web-based intervention program suggests that its application should be promoted in community settings to reduce poor outcomes in people with type 2 diabetes. Tweetable abstract: The web-based transitional care program can improve patients' glycemic control and quality of life. Registration number: ChiCTR2000035603.

Primary sclerosing cholangitis with increased immunoglobulin G4 levels: A case report.

RATIONALE: Primary sclerosing cholangitis (PSC) is recognized as an autoimmune-mediated liver disease characterized by progressive biliary inflammation and fibrosis. Some PSC cases with elevated immunoglobulin G4 (IgG4) levels are likely to be misdiagnosed with immunoglobulin G4-related sclerosing cholangitis (IgG4-SC). Thus, distinguishing these 2 diseases is particularly important. PATIENT CONCERNS: A 34-year-old male presented with right hypochondrium abdominal intermittent pain and jaundice lasting for 1 month. Here, we present a case of PSC with increased IgG4 levels with improvement of quality of life upon liver transplantation (LT). DIAGNOSIS: The diagnosis of PSC was confirmed based on clinical symptoms, laboratory test results, imaging findings, pathologic results and a lack of response to steroid therapy. INTERVENTIONS: LT surgery was performed successfully when his vital parameters were stabilized. Immunosuppressive agents were routinely used after LT. OUTCOMES: Three years after LT, liver function values show that alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were in the normal range. An abdominal ultrasonography showed no obvious abnormalities. LESSONS: There are similar biochemical characteristics and cholangiographic findings between PSC and IgG4-SC. Therefore, distinguishing these 2 diseases is particularly important. LT remains the only option for end-stage PSC. Early diagnosis and effective treatment can achieve a good prognosis.

Regulation and mechanism of leptin on lipid metabolism in ovarian follicle cells from yellow catfish Pelteobagrus fulvidraco.

The present study was conducted to determine the effect of leptin on lipid metabolism in ovarian follicle cells of yellow catfish Pelteobagrus fulvidraco. For that purpose, primary ovarian follicle cells were isolated from yellow catfish, cultured and subjected to different treatments (control, 0.1% DMSO, 500ng/ml leptin, 500ng/ml leptin plus 100µM wortmannin, 500ng/ml leptin plus 50nM AG490, respectively) for 48h. Intracellular triglyceride (TG) content, the activities (CPT I, FAS, G6PD, and 6PGD) and/or expression level of several enzymes (CPT I, FAS, G6PD, 6PGD, ACCa and ACCb), as well as the mRNA expression of transcription factors (PPARα, PPARγ and SREBP-1) involved in lipid metabolism were determined. Recombinant human leptin (rt-hLEP) incubation significantly reduced intracellular TG content, activities and mRNA levels of FAS, G6PD and 6PGD, SREBP-1 and PPARγ, but enhanced activity and mRNA level of CPT I, PPARα and ACCa. Specific inhibitors AG490 and wortmannin of JAK-STAT and IRS-PI3K signaling pathways prevented leptin-induced changes, indicating that JAK-STAT and IRS-PI3K signaling pathways were involved in the process of leptin-induced changes of lipid metabolism. Based on these observations above, for the first time, our study indicated that leptin reduced lipid deposition by activating lipolysis and suppressing lipogenesis in ovarian follicles of yellow catfish, and both JAK-STAT and IRS-PI3K signaling pathways were involved in the changes of leptin-induced lipid metabolism.