[A study on the mediation effect of insulin use on diabetic retinopathy in a community population].

Objective: To explore the risk factors for diabetic retinopathy (DR) in patients with diabetes and the mediating effect of insulin use on the relationship between glycated hemoglobin (HbA1c) and DR. Methods: Cross-sectional study. Random cluster sampling was conducted using a random number table method. A total of 84 sampling points (including 2 pilot points) were selected from the registered population of patients with type 2 diabetes aged 50 years and above at the Disease Prevention and Control Center in Funing County, Jiangsu Province. Questionnaires and biochemical tests were performed to obtain information on the general characteristics of the participants, medical history, insulin use, and glycated hemoglobin (HbA1c) levels. Ocular examinations, including anterior segment and fundus examinations, were conducted. The participants were divided into two groups, DR (diabetic retinopathy) and non-DR, based on the presence or absence of retinal hemorrhages, hard exudates, cotton wool spots, neovascularization, preretinal or vitreous hemorrhage. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors for DR. The Karlson-Holm-Breen analysis method was used for mediation effect analysis. Results: A total of 2 067 diabetic patients were enrolled, of whom 1 965 completed the survey and 1 802 were included in the statistical analysis, resulting in a response rate of 87.2%. Among them, 660 patients were diagnosed with DR, with a detection rate of 36.63%. The results of multivariate analysis showed that diabetes duration (OR=1.166, 95%CI: 1.138-1.196), family history of diabetes (OR=1.325, 95%CI: 1.001-1.755), insulin therapy (OR=1.995, 95%CI: 1.434-2.777), HbA1c level (OR=1.513, 95%CI: 1.189-1.925), and alcohol consumption (OR=0.712, 95%CI: 0.514-0.985) were independent risk factors for DR. The mediating effect of insulin use accounted for 13.67% of the total effect of HbA1c on DR (P<0.001). Conclusions: The risk factors for DR in patients with diabetes include a history of insulin therapy, longer duration of diabetes, family history of diabetes, alcohol consumption, and high HbA1c levels. Insulin use increases the impact of HbA1c on DR and has a partial mediating effect on DR.

[Epidemiology of uncorrected refractive errors in type 2 diabetics aged 50 and above in Funing County, China: the Jiangsu Diabetic Eye Study].

Objective: To estimate the prevalence of uncorrected refractive errors among people aged 50 years and above in Funing county, Jiangsu province. Methods: Randomly cluster sampling was used in selecting individuals aged ≥50 years in 82 clusters from Funing County Center for Disease Prevention and Control. Uncorrected refractive error was defined as an improvement of at least 2 lines in best corrected visual acuity compared with presenting visual acuity in the better eye. The mean±standard deviation was used to describe the continuous data, and the rate or composition ratio was used to represent the classified data. Univariate and multivariate logistic regression analyses were used to analyze the prevalence of uncorrected refractive errors in different ages, genders, educational levels, durations of diabetes and levels of glycosylated hemoglobin. Statistical significance was defined as P<0.05. Results: A total of 2 067 persons were enumerated, and 1910 (92.4%) participants were in the statistical analyses. The prevalence of uncorrected refractive error was 25.63%. The prevalence of uncorrected refractive error for myopia only, hyperopia only, astigmatism only, myopia with astigmatism and hyperopia with astigmatism was 72.55% (37/51), 46.77% (58/124), 17.81% (13/73), 63.95% (94/147) and 51.98% (100/194), respectively. The results showed that the older age, level of glycosylated hemoglobin, myopia and lens state were the independent influencing factors of uncorrected refractive error. The odds ratio (OR) for people aged 70 to<80 years and ≥80 years was 1.81 and 1.90, respectively, with statistical significance compared to people younger than 60 years. Compared with the level of glycosylated hemoglobin less than 5.6%, the OR with glycosylated hemoglobin from7.1% to 8.0% and more than 10% was 1.84 (P<0.05) and 1.82 (P<0.05), respectively. The OR of myopia, low myopia, moderate myopia and high myopia was 2.98 (P<0.01), 6.94 (P<0.01), 42.43 (P<0.01) and 77.85 (P<0.01), respectively. The OR of opacity of the eye lens was 7.60 (P<0.01). Conclusions: Uncorrected refractive error is one of the important causes of visual impairment in diabetic patients aged 50 and above in Funing county, Jiangsu province; the important influencing factors were age, glycosylated hemoglobin concentration, myopia and lens status. Relevant health departments should popularize the eye health for diabetic patients and conduct regular optometry and fundus examination. (Chin J Ophthalmol, 2021, 57: 757-765).

[Jiangsu Diabetic Eye Disease Study：epidemiological survey of blindness and moderate or severe visual impairment in people with type 2 diabetes over 50 years old in Funing County].

Objective: To investigate the prevalence, causes and risk factors of moderate or severe visual impairment and blindness in people with type 2 diabetes over 50 years old in Funing County, Yancheng. Methods: This is a cross-sectional study. Using cluster random sampling, 84 survey sites were selected, and eye examination was performed on people with type 2 diabetes over 50 years old who were registered with the chronic disease information center of Funing County Center for Disease Control and Prevention in Yancheng, Jiangsu. The prevalence of moderate or severe visual impairment and blindness were calculated by different ages and genders. The causes of blindness and visual impairment were determined, and their influencing factors were analyzed by univariate and multivarite logistic regression. Results: A total of 2 067 people were investigated in this study, and 1 909 people were included. The response rate was 92.4%. Based on PVA, the prevalence of blindness and moderate to severe visual impairment was 5.29% (95%CI: 4.29%-6.30%) and 18.54% (95%CI: 16.80%-20.29%). The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, systolic blood pressure and nuclear opacity. The prevalence of moderate or severe visual impairment was related to age, gender, educational level, diabetes treatment, exercise, and glycated hemoglobin. The prevalence of blindness and moderate to severe visual impairment was 3.67% (95%CI: 2.82%-4.51%) and 9.80% (95%CI: 8.46%-11.13%) based on BCVA. The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, exercise and systolic blood pressure, while the prevalence of moderate or severe visual impairment was related to age, educational level, diabetes treatment and nuclear opacity. The primary cause of blindness and visual impairment is cataract, followed by diabetic retinopathy. Conclusions: The prevalence of moderate or severe visual impairment and blindness in people with type 2 diabetes in Funing County is relatively high. Attention should be paid to the prevention of blindness in this population. (Chin J Ophthalmol, 2020, 56: 593-599).

[Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV].

Objective: To explore the clinical characteristics and prognosis of the new coronavirus 2019-nCoV patients combined with cardiovascular disease （CVD). Methods: A retrospective analysis was performed on 112 COVID-19 patients with CVD admitted to the western district of Union Hospital in Wuhan, from January 20, 2020 to February 15, 2020. They were divided into critical group (ICU, n=16) and general group (n=96) according to the severity of the disease and patients were followed up to the clinical endpoint. The observation indicators included total blood count, C-reactive protein (CRP), arterial blood gas analysis, myocardial injury markers, coagulation function, liver and kidney function, electrolyte, procalcitonin (PCT), B-type natriuretic peptide (BNP), blood lipid, pulmonary CT and pathogen detection. Results: Compared with the general group, the lymphocyte count (0.74 (0.34, 0.94)×109/L vs. 0.99 (0.71, 1.29)×109/L, P=0.03) was extremely lower in the critical group, CRP (106.98 (81.57, 135.76) mg/L vs. 34.34 (9.55,76.54) mg/L, P<0.001) and PCT (0.20 (0.15,0.48) µg/L vs. 0.11 (0.06,0.20) µg/L, P<0.001) were significantly higher in the critical group. The BMI of the critical group was significantly higher than that of the general group (25.5 (23.0, 27.5) kg/m2 vs. 22.0 (20.0, 24.0) kg/m2，P=0.003). Patients were further divided into non-survivor group (17, 15.18%) group and survivor group (95, 84.82%). Among the non-survivors, there were 88.24% (15/17) patients with BMI> 25.0 kg/m2, which was significantly higher than that of survivors (18.95% (18/95), P<0.001). Compared with the survived patients, oxygenation index (130 (102, 415) vs. 434 (410, 444), P<0.001) was significantly lower and lactic acid (1.70 (1.30, 3.00) mmol/L vs. 1.20 (1.10, 1.60) mmol/L, P<0.001) was significantly higher in the non-survivors. There was no significant difference in the proportion of ACEI/ARB medication between the critical group and the general group or between non-survivors and survivors （all P>0.05). Conclusion: COVID-19 patients combined with CVD are associated with a higher risk of mortality. Critical patients are characterized with lower lymphocyte counts. Higher BMI are more often seen in critical patients and non-survivor. ACEI/ARB use does not affect the morbidity and mortality of COVID-19 combined with CVD. Aggravating causes of death include fulminant inflammation, lactic acid accumulation and thrombotic events.

[Clinical cohort study of imaging evaluation and postoperative pathology of carotid vulnerable plaque].

Objective: To evaluate the accuracy of contrast-enhanced ultrasound(CEUS) scanning in identifying vulnerable plaque in carotid artery. Methods: The study included a total of 25 patients who suffered from carotid artery stenosis and underwent carotid endarterectomy from January 2016 to December 2017 in Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. Preoperative carotid artery contrast enhanced ultrasound and High-resolution MRI were performed to all patients to determine whether the plaques were stable. All patients then underwent carotid endarterectomy, during which, plaques were completely removed. Biopsies were performed using HE staining and CD31, CD34 and SMA immunohistochemistry was used to identify the plaques properties, including the thickness and integrity of the fiber cap, neovascular endothelium, hemorrhage, and inflammatory cells in the removed plaques.The results of these tests were compared with the diagnosis through the pre-operative imaging. Results: Among twenty-five cases, the pre-operative CEUS revealed sixteen with unstable plaques and nine with stable plaques. Meanwhile the post-operation pathology confirmed seventeen cases with unstable plaque components. The sensitivity of CEUS in the identification of carotid vulnerable plaque was 88.2%(15/17), the specificity was 87.5%(7/8), and the overall diagnostic accuracy was 88%(22/25). The sensitivity, specificity and overall diagnostic accuracy of high resolution MR for vulnerable plaque identification were 83.3%(10/12), 71.4%(5/7), 78.9%(15/19), respectively. There were no significant difference between two groups(χ(2)=0.003, P>0.05). Conclusions: The sensitivity, specificity and overall diagnostic accuracy of the CEUS for vulnerable plaque identification are high.Therefore, CEUS is recommended as one of the pre-operative diagnostic method for unstable plaque in carotid stenosis.

[Clinical efficacy of anterior decompression and stability reconstruction in patients with cervical hyperextension injury].

Objective: To evaluate the clinical efficacy of anterior decompression and stability reconstruction in patients with cervical hyperextension injury. Methods: Postoperative data from 60 patients with cervical hyperextension injury between April 2009 and December 2016 were analyzed retrospectively; the patients included 50 males and 10 females, aged 21-87 years [average, (57±13) years]. All patients had various degrees of spinal cord injury, and were treated with anterior cervical decompression, fusion, and internal fixation.The preoperative and postoperative neurological function were compared to evaluate the clinical efficacy of the treatment.The t test was applied when preoperative and postoperative data were compared. Results: Of the 60 patients, 5 underwent anterior cervical discectomy and fusion, 26 underwent anterior cervical corpectomy and fusion, and 29 received treatment with the hybrid technique.The average follow-up was (5.1±2.1) years (range, 1.6-9.1 years). The American Spinal Injury Association (ASIA) scores, abbreviated injury scale (AIS grades), and Japanese Orthopedic Association Scores (JOA scores) at the 1 week post operation and final follow-up were significantly better than those obtained preoperatively (all P<0.01). The JOA scores before operation and at the final follow-up was 10(7, 11) and 16(14, 17), respectively.Based on the recovery rate of JOA scores, the rate of cure was 28.3% (17 cases), the rate of significant efficiency was 60.0% (36 cases), the rate of efficiency was 8.3% (5 cases), the rate of inefficiency was 3.3% (2 cases). Among the patients showing cure, 5 were satisfied with the life function, however, the extent of their injury was still of Grade D owing to the incomplete recovery of muscle force.Further, when the 60 patients were divided into A and B groups according to whether they had congenital spinal stenosis or not, respectively, and no significant difference was found in ASIA scores, AIS grades and JOA scores between the groups (all P<0.01). Conclusion: Anterior cervical decompression, fusion and internal fixation is safe and effective for cervical hyperextension injury without continuous-type ossification of the posterior longitudinal ligament.

[Epidemiological survey of visual impairment in Funing County, Jiangsu].

Objective: To investigate the prevalence of visual impairment and factors associated with visual impairment among people aged 50 years and above in Funing County, Jiangsu Province. Methods: Cross-sectional study. Random cluster sampling was used in selecting individuals aged ≥50 years in 30 clusters, and 5 947 individuals received visual acuity testing and eye examination. Stata 13.0 software was used to analyze the data. Multivariate logistic regression was used to detect possible factors of visual impairment such as age, gender and education. Statistical significance was defined as P< 0.05. Results: A total of 6 145 persons aged 50 years and above were enumerated, and 5 947 (96.8%) participants were examined. Based on the criteria of World Health Organization (WHO) visual impairment classification and presenting visual acuity, 138 persons were diagnosed as blindness, and 1 405 persons were diagnosed as low vision. The prevalence of blindness and low vision was 2.32% and 23.63%, respectively. And the prevalence of visual impairment was 25.95%. Based on the criteria of WHO visual impairment classification and best-corrected visual acuity, 92 persons were diagnosed as blindness, and 383 persons were diagnosed as low vision. The prevalence of blindness and low vision was 1.55% and 6.44%, respectively. And the prevalence of visual impairment was 7.99%. Concerning presenting visual acuity and best-corrected visual acuity, the prevalence of blindness and low vision was higher in old people, females and less educated persons. Cataract (46.63%) was the leading cause of blindness. Uncorrected refractive error (36.51%) was also a main cause of visual impairment. Conclusion: The prevalence of visual impairment is higher in old people, females and less educated persons in Funing County, Jiangsu Province. Cataract is still the leading cause of visual impairment. (Chin J Ophthalmol, 2017, 53: 502-508).

[A meta-analysis of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair].

Objective: This study was aim to compare the efficacy and safety of percutaneous access and open femoral exposure for endovascular aortic aneurysm repair. Methods: Eligible studies were searched from PubMed, Embase, and Corchrane databases published in English from January 1999 to December 2015. Data extracted from each study were synthesized into overall odds ratios (OR) for technical success rates and complications. The outcomes on technical success rates and complications of both totally percutaneous access and open femoral exposure group were compared. Results: After a systematic review of English language articles, ten studies including 1 504 patients were eligible for the Meta-analysis. The technical success rates of the percutaneous endovascular aortic aneurysm repair (PEVAR) group was 95.1%, close to that of femoral exposure (FE) group (97.5%). The difference did not show significantly (OR=0.57, 95% CI: 0.31-1.04, P>0.05). However, the incidence of total postoperative complications in PEVAR group was 8%, significantly lower than that in FE group (15.9%) (OR=0.52, 95% CI: 0.37-0.42, P<0.01). Conclusion: PEVAR is associated with a similar technical success rate and lower complication incidence rate comparing with FE. Therefore, it could be as a preferred approach of endovascular aortic aneurysm repair.

CTLA-4 and CD86 genetic variants and haplotypes in patients with rheumatoid arthritis in southeastern China.

The cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and costimulatory molecule (CD80/CD86) genes are important susceptibility genes associated with autoimmune diseases. CTLA-4 polymorphisms have been found to be associated with various autoimmune diseases. However, the association data are inconsistent for rheumatoid arthritis (RA). We investigated the genetic association of CTLA-4 and CD86 polymorphisms with RA in a Chinese population. Four single nucleotide polymorphisms (SNPs) (rs5742909 and rs231775 in CTLA-4, and rs17281995 and rs1129055 in CD86) were genotyped in 213 patients with RA and 303 healthy controls using polymerase chain reaction-restriction fragment length polymorphism. The genotype and allele distributions of rs5742909 differ significantly between RA patients and controls (P < 0.05) and the dominant model was found to be the best inheritance model. Stratification studies showed that CTLA-4 gene polymorphisms were more significantly associated with rheumatoid factor-negative and anti-cyclic citrullinated peptide-negative subgroups in the southeastern Han Chinese population. We also found that the haplotype of 2 CTLA-4 SNPs showed significant association with the disease (P = 0.0025) with the T-A (OR = 1.88, 95%CI = 1.12-3.15) and T-G (OR = 3.45, 95%CI = 1.10-10.87) haplotypes being observed more frequently in cases than in controls. We failed to find any significant association of the 2 CD86 SNPs with RA. These results indicate that the polymorphisms of CTLA-4 (rs5742909) may be important genetic factors for RA risk in the southeastern Han Chinese population.

Genetic diversity of Aquilegia (Ranunculaceae) species and cultivars assessed by AFLPs.

Species of the genus Aquilegia are exceptionally diverse in their floral morphology and color, commonly known as columbine. They are widely planted ornamentals and are highly attractive for hummingbirds. However, little is known about their genetic diversity. We examined the genetic diversity of the species and cultivars using amplified fragment length polymorphism (AFLP) markers. Sixteen EcoRI/MseI AFLP primer combinations produced 327 informative polymorphic bands, with a mean of 20.4 bands scored per primer. Jaccard's coefficient of similarity varied from 0.61 to 0.93, indicative of high levels of genetic variation. Cluster analysis using the unweighted pair group method with arithmetic mean algorithm placed the 64 accessions into two main clusters, each divided into two sub-clusters. The AFLP variability was significantly associated with the geographic origins, as the Asian species and the North American species grouped into two distinct clusters. The genetic diversity found among Aquilegia demonstrated the potential value of Chinese germplasm for cultivar improvement and for widening the genetic basis of breeding programs and breeding material selection. We concluded that AFLPs are informative and can provide significant insights for genetic diversity research in columbine species.

Preparation, characterization, and anti-tumor property of podophyllotoxin-loaded solid lipid nanoparticles.

In an effort to develop an alternative formulation of podophyllotoxin suitable for drug release and delivery, podophyllotoxin-loaded solid lipid nanoparticles (PPT-SLNs) were constructed, characterized and examined for in vitro cytotoxicity and tumor inhibition. The SLNs were prepared by using a solvent emulsification-evaporation method, and their size was around 50 nm. TEM detection showed that the SLNs were homogeneous and spherical in shape, and differential scanning calorimetry (DSC) measurement revealed a new conformation of PPT-SLNs. An in vitro drug release study showed that PPT was released from the SLNs in a slow but time-dependent manner. Furthermore, the treatment of 293T and HeLa cells with PPT-SLNs demonstrated that PPT-SLNs were less toxic to normal cells and more effective in anti-tumor potency compared with unconjugated PPT. A colony forming efficiency assay showed an effective long-term cancer growth suppression of PPT-SLNs; in addition, they can also enhance the apoptotic and cellular uptake processes on tumor cells compared with PPT. These results collectively demonstrated that this SLN formulation has a potential application as an alternative delivery system for anti-tumor drugs.