ABSTRACT
As one of the most common acute complications of diabetes, hypoglycemia can occur in any diabetic patients. Multiple risk factors can lead to the occurrence of hypoglycemia, but the risk of hypoglycemia is generally ignored in clinical practice. Therefore, attention should be paid to identifying high-risk population, strengthening blood glucose monitoring, and selecting reasonable diabetes treatment programs and health education. Hypoglycemia is associated with a variety of adverse outcomes, especially nervous system injury. In clinical practice, it is necessary to prevent and improve hypoglycemia complications and reduce glucose reperfusion brain injury. Continuous blood glucose monitoring technology and the new glucagon nasal spray powder have shown positive effects in the management of hypoglycemia, but there are still many challenges that need further research and exploration.
ABSTRACT
Objective:To explore the changes of bone turnover markers induced by sleep deprivation (SD) and the effect of melatonin supplementation on the bone turnover status.Methods:Six-week-old Wistar male rats were divided into SD, normal control (NC), and melatonin supplementation (SD+ MT) groups. Acute SD model was established using a modified multi-level bench method. The bone turnover markers, corticosterone, and melatonin in serum as well as Cathepsin K(CTSK) mRNA expression in bone tissue were tested.Results:Acute SD disrupted the balance between bone formation and bone absorption evidenced by rapid decreased serum procollagen type Ⅰ N-terminal propeptide (PⅠNP) levels and increased β cross-linked C-telopeptide of type Ⅰ collagen (β-CTX) levels ( P=0.003) from 24 h to 72 h. The exogenous melatonin treatment decreased β-CTX [(512.4±95.8) ng/mL vs (696.0±76.5) ng/mL, P=0.004] and the osteoclast-related gene CTSK mRNA level after 72 h SD. Conclusions:Acute SD accelerates bone resorption, which could be partially alleviated by melatonin supplementation.
ABSTRACT
This study summarizes the construction background, rules and regulations and institutional settings of the MOOC and Micro-course Club in the Second Hospital of Jilin University, discusses the means of teacher training for clinical teachers, and shows the application effect of the club. At the same time, the related problems encountered in the process of club construction are summarized and reflected. The construction of MOOC and micro-course clubs is conducive to improving the information-based teaching level of clinical teachers, and also provides new inspiration and ideas for the construction of medical clubs.
ABSTRACT
Objective@#To investigate the relationship between depressive symptoms and dietary behaviors among middle school and college students in Beijing，so as to provide the basis for carrying out related research and intervention.@*Methods@#A total of 18 130 middle school and college students from 16 districts in Beijing were collected through stratified cluster sampling from October to December, 2020. The relationship between middle school and college students depressive symptoms and dietary behaviors was analyzed by conducting a questionnaire.@*Results@#The detection rate of depressive symptoms was 18.2%. The detection rate of depressive symptoms in girls was 19.0%, which was higher than 17.4% in boys( P <0.05), and the differences were of statistical significance( χ 2=8.47, P <0.01). The detection rate of depressive symptoms in city was 17.9%, and in 10 urban areas was 18.5 %( P > 0.05 ), and the differences were of statistical significance( χ 2=1.15, P =0.28). The detection rates of depressive symptoms in vocational high school (21.8%) and high school students(20.6%) were and, higher than that in college students (18.2%) and in junior high school students(15.2%), and the differences were of statistical significance( χ 2=100.38, P <0.01). The rates of students with depressive symptoms drinking sugary drinks(14.4%), eating sweets (22.1%) and eating fried foods every day (12.4%) were higher than that of students without depressive symptoms(7.6%, 12.0%, 5.9%), and the differences were of statistical significance( χ 2=154.62, 215.67, 164.49, P <0.01). The rates of eating fresh fruits(63.3%), vegetables (81.7%) and breakfast every day (53.4%) of the students with depressive symptoms were lower than those without depressive symptoms (72.0%, 88.1%, 74.1%), and the differences were of statistical significance( χ 2=90.77, 90.59, 518.69, P <0.01) Logistic regression analysis showed that the detection rate of depression was the important factor of influencing dietary behaviors( P <0.05).@*Conclusion@#The detection rates of depressive symptoms of vocational high school students and senior high school students in Beijing are higher than those of junior high school students and college students. Depression is closely related to dietary behaviors. Promoting students mental health may help promote students healthy eating.
ABSTRACT
Objective:To investigate the correlation between Helicobacter Pylori (HP) infection and abdominal obesity. Methods:A total of 1728 subjects who underwent routine health check-up and 13C or 14C urea breath test at the Health Management Center of Beijing Hospital from January 2018 to December 2018 were enrolled. The correlation between HP infection and metabolic syndrome (MS) components was analyzed. Results:There was no significant difference in HP infection rate between MS group and non-MS group [73.3%(360/491) vs. 68.7%(850/1 237), χ2=3.55, P=0.060]. The prevalence of abdominal obesity and elevated fasting blood glucose in HP positive subjects was significantly higher than that in HP negative subjects [71.7%(352/491) vs. 65.4%(809/1 237),χ2=6.36, P=0.042;80.7%(396/491) vs. 75.9%(939/1 237),χ2=4.50, P=0.034]. The non-obesity rate of HP positive subjects [28.1%(138/491)] was lower than that of HP negative subjects [34.3%(424/1 237), χ2=6.36, P=0.042). There were no significant differences in rates of hypertension, high triglyceride and low HDL-C, increased total cholesterol, increased LDL-C between HP-positive and HP-negative subjects (all P>0.05).There was no significant difference in HP positive rate between MS and non-MS groups [29.8%(360/1 210) vs. 25.3%(131/518), χ2=3.55, P=0.060]. The HP positive rate in subjects with abdominal obesity was higher than that with normal abdominal circumference [30.3%(352/1 161) vs. 24.5%(139/567), χ2=6.31, P=0.012], and the HP positive rate in subjects with elevated fasting blood glucose (FBG) was higher than that with normal FBG [29.7%(396/1 335) vs. 24.2%(95/393), χ2=4.50, P=0.034]. The HP infection rate was not associated with hypertension, hypertriglyceridemia and low HDL-C. Logistic regression analysis showed that abdominal obesity ( OR=1.327, P=0.016) was the risk factor of HP infection; and HP infection was the risk factor of abdominal obesity ( OR=1.277, P=0.043). Conclusion:HP infection is positively correlated with abdominal obesity and may be correlated with elevated fasting blood glucose, but not with other components of metabolic syndrome in health check-up population.
ABSTRACT
Elderly patients with diabetes often have multiple co-morbidities, comprehensive geriatric health assessment and highly individualized management should be emphasized for them. In recent years, with the emerging of new hypoglycemic drugs the treatment for elderly diabetic patients has advanced, which offers new options and challenges in the management and treatment of elderly diabetic patients with multiple comorbidities.
ABSTRACT
The importance of glucose measurement in the treatment of diabetes can not be overstated. However, the compliance with blood glucose measurement is low because most of the measurement of blood glucose monitor are invasive or minimal invasive. Non-invasive technology can reduce discomfort, improve adherence of blood glucose monitor by the guidelines, facilitate glycemic control, and subsequently lower the prevalence of acute and chronic complications. It is expected that large-scale clinical application will be possible in the future if accurate data can be obtained and costs can be controlled in the non-invasive measurement of blood glucose. This review overviewed the current technology accuracy, advantages, disadvantages, and potential limitations of non-invasive blood glucose measurement.
ABSTRACT
Objective:To analyze changes in nutritional status and immune function of elderly men receiving regular physical examinations, and to investigate the effects of aging on the nutritional status and immune function among elderly men.Methods:A total of 209 elderly men aged 60-101(72.9±11.5)years and receiving regular physical check-ups were enrolled.All research subjects were subjected to nutritional risk screening(NRS2002)and monitoring of nutrition and immune-related indicators, including routine blood work, blood biochemistry, immunoglobulin and T lymphocyte subsets.Results:Body weight, body mass index, hemoglobin, total protein, albumin and serum iron of elderly men decreased with age( F=21.754, 6.257, 47.528, 12.285, 18.397, 18.667, all P<0.001), with those aged 80 and above showing more significant decline and a greater proportion with malnutrition( χ2=77.134, P<0.001). The B lymphocyte counts of elderly men aged 80 and above were significantly lower( P<0.05)while serum IgA and IgG levels were significantly higher( F=3.110, 3.866, P=0.047, 0.022)than those of the 70-79 year old group.In addition, the B lymphocyte count and B lymphocyte ratio in malnourished elderly men were significantly lower( t=2.512, 2.874, P=0.013, 0.005), and IgA was significantly increased( t=2.513, P=0.017), compared with those with normal nutrition. Conclusions:The risk of malnutrition and reduced immune function among elderly men aged 80 years and above is significantly increased, and assessment and screening of the risk of malnutrition in the elderly should be stressed.
ABSTRACT
The human spine injury and various lumbar spine diseases caused by vibration have attracted extensive attention at home and abroad. To explore the biomechanical characteristics of different approaches for lumbar interbody fusion surgery combined with an interspinous internal fixator, device for intervertebral assisted motion (DIAM), finite element models of anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are created by simulating clinical operation based on a three-dimensional finite element model of normal human whole lumbar spine. The fusion level is at L4-L5, and the DIAM is implanted between spinous process of L4 and L5. Transient dynamic analysis is conducted on the ALIF, TLIF and LLIF models, respectively, to compute and compare their stress responses to an axial cyclic load. The results show that compared with those in ALIF and TILF models, contact forces between endplate and cage are higher in LLIF model, where the von-Mises stress in endplate and DIAM is lower. This implies that the LLIF have a better biomechanical performance under vibration. After bony fusion between vertebrae, the endplate and DIAM stresses for all the three surgical models are decreased. It is expected that this study can provide references for selection of surgical approaches in the fusion surgery and vibration protection for the postsurgical lumbar spine.
Subject(s)
Humans , Biomechanical Phenomena , Finite Element Analysis , Lumbar Vertebrae/surgery , Pedicle Screws , Range of Motion, Articular , Spinal Fusion , VibrationABSTRACT
Objective:The aim of the present study was to observe the effects of liralutide on body composition and muscle function in adult obese patients with type 2 diabetes.Method:A total of 63 adult obese type 2 diabetic patients who were (52.6±9.7) years of age and with body mass index (BMI) of ≥28 kg/m 2 were enrolled. The patients were randomly assigned into two groups. On the basis of maintaining the original hypoglycemic regimen, patients in the control group ( n=24) were given dietary guidance only, and those in the treatment group ( n=39) were injected with liraglutide. All patients were followed up for a period of 12 weeks. Blood glucose, glycosylated hemoglobin(HbA1c) and insulin levels, liver and kidney function, body composition assessed with electrical impedance methods, and grip strength measured by a grip meter for muscle function were detected at the baseline and the end of the study. Results:Compared with those in the control group, the reductions in HbA1c [(-1.54±2.10) % vs.(-0.53±0.84) %], body weight [(-3.46±4.2) kg vs.(-0.34±3.66) kg], body fat mass [(-1.97±2.98) kg vs.(-0.01±2.16) kg] and visceral fat area [(-0.01±2.16) cm 2 vs.(0.34±6.39) cm 2] were more pronouced in liraglutide treated group (all P<0.05). However, no changes could be observed in muscle mass and grip strength after liraglutide treatment. Conclusions:In addition to reducing blood glucose, body weight and fat mass, treatment with lilaluptide had no impact on muscle mass and muscle function. Therefore, liralutide is suitable for obese patients with type 2 diabetes, especially for weight management patients who are at risk of muscle loss.
ABSTRACT
Elderly diabetic patients in China accounts for one fourth of the total number of elderly diabetic patients in the world, ranking the first worldwide. In 2021, National Center of Gerontology, Chinese Society of Geriatrics and Diabetes Professional Committee of Chinese Aging Well Association issued China′s first guideline on elderly diabetic patients——Guideline for the management of diabetes mellitus in the elderly in China (2021 edition). The present article interprets parts of the important recommendations of the guideline, aiming to facilitate its implementation in clinical practice effectively and improve the clinical prognosis of elderly diabetic patients in our country.
ABSTRACT
Objective:To investigate the characteristics of changes in muscle quality and strength in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 670 patients(320 males and 350 females)aged 50 years and over from the endocrinology departments of 9 hospitals in Beijing were recruited as the type 2 diabetes mellitus group(T2DM group)by using systematic random sampling, and 214(54 males and 75 females)age-matched Beijing Hospital retirees without T2DM were randomly enrolled as the control group.Body composition was measured by using bioimpedance analysis.Low muscle mass was defined as appendicular skeletal muscle mass index(ASMI)below 7.18 kg/m 2 in men and 5.73 kg/m 2 in women.Low muscle strength was defined as grip strength below 29.5 kg in men and 21.2 kg in women.Sarcopenia was defined by the presence of low muscle mass with low grip strength.Muscle quality was calculated by grip strength divided by muscle mass of the dominant upper limb, and muscle strength per mass unit was compared.Multivariate Logistic regression was used for correlation analysis. Results:The fasting blood glucose(FPG)level, the waist to hip ratio, the percentages of smokers and drinkers, and the proportions of subjects with concurrent hypertension and coronary heart disease were higher in the T2DM group than in the control group( P<0.05 or 0.01). Compared with the control group, grip strength and muscle quality decreased significantly in male T2DM patients( t=4.408 and 3.972, P<0.01). In male participants, BMI( t=-5.567, 95% CI: -0.375~-0.179, P<0.01)and glycated hemoglobin(HbA1c)( t=-2.322, 95% CI: -0.420~-0.035, P<0.05)were negatively correlated with muscle quality, while old age( OR=1.062, 95% CI: 1.023~1.103, P<0.01; OR=1.074, 95% CI: 1.027~1.122, P<0.01)and increased HbA1c level( OR=1.062, 95% CI: 1.023~1.103, P<0.01; OR=1.074, 95% CI: 1.027~1.122, P<0.01)were risk factors for low muscle strength and sarcopenia. Conclusions:Compared with non-diabetes patients, muscle quality and strength decrease significantly in middle-aged and elderly male T2DM patients.Besides aging, increased levels of HbA1c and BMI are risk factors for low muscle quality and strength.
ABSTRACT
Objective To investigate the metabolic characteristics,body composition and dietary intake in elderly sarcopenia patients with type 2 diabetes(T2DM).Methods A total of 652 T2DM patients(327 males and 325 females)aged over 60 years were selected from endocrinology department of nine different hospitals in Beijing.Body composition was measured by bioimpedance analysis,and the appendicular skeletal mass index(ASMI)was calculated.Sarcopenia was defined as body height-adjusted skeletal muscle mass (ASMI)below the lower quintile of the young reference group.The diagnostic cutoff points for sarcopenia were 7.18 kg/m2 for men and 5.73 kg/m2 for women.All patients were divided into the sarcopenia group versus the control group(below vs.not below 7.18 kg/m2 for men and 5.73 kg/m2 for women).The anthropometric parameters,body composition,biochemical laboratory results and dietary intake were compared between the two groups.The blood glucose target levels were less than 7 mmol/L of fasting plasma glucose(FPG)or less than 7％ of haemoglobin A1c(HbA1c).The obesity ratio was calculated according to body fat percentage more than 25％ in men and more than 30％ in women as obesity.Results There were 116 (17.8％)patients in the sarcopenia group (men/women,82/34),and 536 (82.2 ％) patients in the control group (men/women,245/291).Age was higher in the sarcopenia group than in the control group(t =4.385,P =0.000),and body mass index and waist hip ratio(WHR)were lower in the sarcopenia group than in the control group(t =11.724 and 4.173,P=0.000 and 0.000).FPG[(7.5±2.4) mmol/L vs.(8.5±2.5)mmol/L,t =-3.450,P=0.001]and HbA1c[(7.0±1.6) ％ vs.(8.2± 1.7) ％,t =-5.745,P =0.000] were higher in male sarcopenia group than in male control group.The control rate of FPG (127.0％ or 51.8％ vs.27.0％ or 32.9％,x2=8.817,P=0.003)and HbA1c(131.0％ or 53.5％ vs.23.0％ or 28.0％,x2 =15.934,P=0.000)were lower in the sarcopenia group than in the control group.The red blood cell counts,hemoglobin and serum albumin levels,estimated glomerular filtr ationrate(eGFR)were lower in male sarcopenia group than in the male control group(P＜0.05).eGFR was lower in female sarcopenia group than in female control group(t =4.090,P =0.000).Both in men and women,ASMI,grip power,fatless circumference on upper arm,bone mineral content and basal metabolic rate were lower in the sarcopenia group than in the control group(P＜0.05).The total daily intake of energy,carbohydrate,protein and fat were lower in male sarcopenia group than in male control group(P＜ 0.05).Conclusions Compared with the control group,sarcopenia patients are older with worse glycemic control and lower levels of BMI,WHR,renal function,muscle mass and muscle strength.Sarcopenia patients are more prone to osteoporosis.Furthermore,they have poorer nutritional status with an imbalance of dietary intake.Appropriate increase of protein especially high quality protein intake should be recommended to sarcopenia patients with T2DM.
ABSTRACT
Present study is conducted to investigate the efficacy and safety of application of low-molecular-weight heparin calcium in the prophylaxis of deep venous thrombosis [DVT] following the laparoscopic surgery for gynecological tumors, so as to provide reference for the selection of anti-coagulant procedure in clinical practice. A total of 180 patients who underwent the laparoscopic surgery for the gynecological tumors in this hospital between January 2015 and December 2017 were enrolled in this study, and according to the anti-coagulant procedure, they were divided into two groups, i.e. the control group and the observation group, with 90 patients in each group. In the control group, 90 patients were free from the anti-coagulant agent or drugs affecting the coagulant functions, while those in the observation group received the subcutaneous injection of low-molecular-weight heparin calcium for consecutive 5 days. Then we compared the serological indicators, prothrombin time [PT], cross-section diameter of the lower limb, hemodynamic indicator and the incidence rate of complications. Following postoperative 5 days, the levels of fibrinogen and D-dimer in the observation group were [2.66 +/- 0.72] g/L and [0.61 +/- 0.17] microg/mL, significantly lower than those in the control group, and the differences had statistical significance [t=4.667, P=0.019; t=3.967, P= 0.029]. At 3 d and 5 d after operation, PTs in the observation group were [13.74 +/- 3.92] s and [13.84 +/- 3.13] s, also superior to the control group [t=3.031, P=0.042; t=3.553, P =0.034]. In the observation group, the cross-section diameter of lower limb and blood flow rate were [20.22 +/- 3.51] cm and [0.93 +/- 0.17] m/s, respectively, which were better than the control group, and the difference had statistical significance [t=4.412, P=0.021; t =4.724, P=0.019]. In the observation group, the incidence rate of complications was only 3.33%, significantly lower than 10.00% in the control group [c2 =6.158, P=0.004]. The application of the low-molecular-weight heparin calcium for anti-coagulation in the prophylaxis of the DVT following the laparoscopic surgery of gynecological tumor can better ameliorate the hemodynamics of patients, and prevent the formation of DVT
ABSTRACT
Objective To understand the overweight rate and obesity rate in middle-aged and elderly people in urban area of Beijing,and analyze the changes of body composition and resting metabolic rate with age.Methods From November 2014 to December 2015,body composition measurement and resting metabolic rate detection were conducted among 858 people aged 51 to 99 years,including 760 men,98 women,who received physical examination at Beijing Hospital.Results The overweight rate was 51.4％,and the obesity rate was 16.9％.The overweight rate was 26.5％ and the obesity rate was 14.3％ in women,significantly lower than those in men (54.6％ and 17.2％) (P＜0.001).The distribution of skeletal muscle volume,muscle index,body fat percentage,visceral fat area and resting metabolic rate in different age groups were different (P＜0.001).In the normal weight group,the skeletal muscle volume,muscle index and resting metabolic rate in age group ≥80 years decreased obviously (P＜0.05).At the same time,the body fat percentage and visceral fat area increased obviously (P＜0.05).However,the skeletal muscle volume,muscle index and resting metabolic rate of the overweight and obese groups began to decrease obviously in age group 70-years (P＜0.05),and the decrease in age group ≥80 years was more obvious.At the same time,body fat percentage and visceral fat area increased significantly in age group 70-years (P＜ 0.05).Conclusion The overweight and obesity rates were high in the middle-aged and elderly people in the urban area of Beijing,and the rates were higher in men than in women.With the increase of age,the skeletal muscle volume,muscle index and resting metabolic rate gradually decreased,while the percentage of body fat and visceral fat area increased;Overweight and obese people had earlier changes in body composition and resting metabolic rate.
ABSTRACT
Objective To understand the overweight rate and obesity rate in middle-aged and elderly people in urban area of Beijing,and analyze the changes of body composition and resting metabolic rate with age.Methods From November 2014 to December 2015,body composition measurement and resting metabolic rate detection were conducted among 858 people aged 51 to 99 years,including 760 men,98 women,who received physical examination at Beijing Hospital.Results The overweight rate was 51.4％,and the obesity rate was 16.9％.The overweight rate was 26.5％ and the obesity rate was 14.3％ in women,significantly lower than those in men (54.6％ and 17.2％) (P＜0.001).The distribution of skeletal muscle volume,muscle index,body fat percentage,visceral fat area and resting metabolic rate in different age groups were different (P＜0.001).In the normal weight group,the skeletal muscle volume,muscle index and resting metabolic rate in age group ≥80 years decreased obviously (P＜0.05).At the same time,the body fat percentage and visceral fat area increased obviously (P＜0.05).However,the skeletal muscle volume,muscle index and resting metabolic rate of the overweight and obese groups began to decrease obviously in age group 70-years (P＜0.05),and the decrease in age group ≥80 years was more obvious.At the same time,body fat percentage and visceral fat area increased significantly in age group 70-years (P＜ 0.05).Conclusion The overweight and obesity rates were high in the middle-aged and elderly people in the urban area of Beijing,and the rates were higher in men than in women.With the increase of age,the skeletal muscle volume,muscle index and resting metabolic rate gradually decreased,while the percentage of body fat and visceral fat area increased;Overweight and obese people had earlier changes in body composition and resting metabolic rate.
ABSTRACT
Objective@#To investigate the expression of succinate dehydrogenase complex subunit protein in succinate dehydrogenase-deficient gastrointestinal stromal tumors (SDH-deficient GISTs).@*Methods@#Three hundred fifty-two cases of GISTs were collected from January 2003 to January 2017 at the Affiliated Hospital of Guizhou Medical University and West China Hospital of Sichuan University.The expression of succinate dehydrogenase subunit protein was detected by immunohistochemical EnVision technique in 352 cases of GISTs, and the negative cases were analyzed for clinicopathologic features and outcome. The gene segments of CKIT exons 9, 11, 13 and 17 and PDGFRA exons 12 and 18 were amplified and detected in SDH-deficient (negative) cases.@*Results@#A total of 15 SDHB-deficient (negative) GISTs (4.3%, 15/352) were found among 352 cases of GISTs. Six patients were male and nine were female. The age of initial diagnosis ranged from 15 to 84 years (median=53 years, mean=47 years). The tumor involved stomach (14 cases) and mesentery (1 case). The tumor sizes varied from 0.5 cm to 15.0 cm (mean=6.9 cm). There were six, six and three cases of epithelioid, mixed and spindle cell types respectively. Eight cases showed multi-nodularity in the wall of stomach. Metastasis to lymph node was noted in four cases, one case showed intraperitoneal implantation metastasis. Metastases to liver, pancreas and lymph node were found in one case, and one case showed vascular invasion. Among SDHB-deficient GISTs, two SDHA-deficient (negative) cases were found (0.6%, 2/352), but there were no SDHC and SDHD deficient (negative) cases. Five of the fifteen SDH-deficient GISTs had follow-up data: one patient died 8 months after surgery from unknown cause, four had no recurrences or metastases, and there was no history of paraganglioma and pulmonary chondroma found in patients and their families. No mutation in CKIT and PDGFRA gene was identified in 15 cases of SDH-deficient GISTs.@*Conclusion@#SDH-deficient GISTs have unique clinicopathologic features and a favorable prognosis, and a small proportion of cases are SDHA-deficient.
ABSTRACT
Objective To investigate the risk factors and appropriate screening methods for diabetic peripheral neuropathy (DPN ). Methods This research is a multicenter ,randomized ,cross-sectional study. Questionnaires ,physical examinations and laboratory tests were performed on 1054 elderly diabetic outpatients at 13 hospitals in urban and rural areas of Beijing. Patients were screened for DPN with the five physical examinations recommended by the Diabetes Branch of the Chinese Medical Association. They were divided into a confirmed DPN group(n=449 ,42.6％ ) ,a suspected DPN group(n=276 ,26.2％ ) ,and a non-DPN group(n=329 ,31.2％ ).Multivariate logistic regression was used to analyze risk factors for DPN.The sensitivity ,specificity ,Youden index ,and area under the receiver operating characteristic (ROC)curve were calculated and used for evaluating each test and their combinations in screening DPN and for choosing the opitmal test combination. Results The differences in age ,family income ,duration of diabetes ,glycated hemoglobin(HbA1c) ,hypoglycemia ,and dyslipidemia among three groups were statistically significant (all P<0.01). The decision whether or not to initiate metformin therapy ,metformin doses and DPN prevalence in patients on long-term metformin therapy showed statistically significant differences among three groups (all P<0.01). The differences in the prevalences of cerebral infarction ,diabetic retinopathy ,and peripheral vascular disease among three groups were statistically significant (all P< 0.05).Multivariate Logistic regression analysis suggested that levels of HbA1c ,hypoglycemia ,LDL cholesterol ,whether or not metformin use , metformin dose ,and duration of metformin use were risk factors for DPN in elderly diabetics (all P<0.05) . The combined methods of ankle reflex ,vibratory sensation and temperature sensation used for screening DPN showed the best results with a sensitivity of 94.1％ ,specificity of 75.3％ ,an area under the ROC curve of 0.847 ,and a Yoden index of 0.6945. Conclusions The prevalence of DPN in elderly diabetic outpatients at third-level referral hospitals in Beijing is high. Poor glycaemic control ,repeated episodes of hypoglycemia , metformin use and its daily dose and duration are risk factors for DPN in elderly diabetics.We should focus on strengthening the DPN screening and management of high-risk population.Symptoms of peripheral neuropathy plus ankle reflex ,vibratory and temperature sensations are simple ,rapid and reliable DPN-screening methods ,and can be promoted in outpatient department and primary hospitals.
ABSTRACT
Objective To investigate the association between serum total testosterone (TT ) levels and type 2 diabetes(T2DM )and any gender differences in elderly patients. Methods Based on the Aging Health database built from 2008 to 2012 ,935 elderly individuals over 60 years old with a mean age of 65.8 years receiving physical examinations were included.According to the 1999 WHO criteria for diabetes ,participants were assigned into four groups :a T2DM group(n＝298) ,an impaired fasting glucose(IFG)group(n＝26) ,an impaired glucose tolerance(IGT)group(n＝121) ,and a normal glucose regulation(NGR)group(n ＝ 490).We measured serum TT by ELISA and analyzed the distribution patterns in the groups.Furthermore ,we examined the gender-specific correlation of TT with T2DM and homeostasis model assessment of insulin resistance (HOMA-IR). Results The prevalence of T2DM in the participants was 31.9%(298/935).One-way ANOVA analysis showed that the TT level was higher in the NGR group than in the T2DM and IGT groups (PANOVA＝ 0.001) . Logistic regression analysis indicated a significant protective association between TT and T 2DM in the elderly.Every one unit of increase in the SD of the TT level was accompanied by a 23% reduction in the risk for T2DM (P＝ 0.001).Further gender-stratification analysis suggested that the protective role of TT against T2DM only existed in males (OR＝ 0.55 ,95% CI :0.44-0.68 ;P＜ 0.001).After adjustment for age ,blood pressure ,blood lipids ,and waist circumference ,the protective role of TT against T2DM in males still remained (OR ＝ 0.68 ,95% CI :0.53-0.86 ;P ＝ 0.002 ).Pearson correlation analysis also indicated a significant negative correlation between TT and HOMA-IR in older males(P＝0.002).As for older females ,no significant correlation of TT with T2DM and HOMA-IR was found. Conclusions The serum TT level might be an independent protective factor for T 2DM in older males ,as evidenced by its correlation with improved insulin resistance status ,which is not present in older females.
ABSTRACT
Objective To observe the clinical effect of drug moxibustion in the treatment of chronic obstructive pulmonary disease (COPD).Methods A total of 90 patients with acute myocardial infarction in Taihe Hospital emergency department were randomly divided into the control group (n=30) and the treatment group (n=90).The patients in the control group were treated with routine western medicine, while treatment group was treated with drug moxibustion on the basis of the control group treatment. Both groups were treated for 6 weeks.The pulmonary function was assessed, and the clinical effect was evaluated.Results The total effective rate was 86.7% (52/60) in the treatment group and 70.0% (21/30) in the control group. The difference between the 2 groups was statistically significant (χ2=6.059,P=0.048). After treatment, the forced expiratory volume in 1 second (FEV1) (1.07 ± 0.3l L vs. 1.05 ± 0.41 L,t=15.272) in the treatment group were significantly higher than that in the control group (P<0.01).Conclusions The drug-separated moxibustion can improve the curative effect and improve the lung function of patients with stable COPD.