Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register.

Background: Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO. Methods: Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models. Results: In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12). Conclusion: Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.

Association between dietary supplement use and mortality among US adults with diabetes: a longitudinal cohort study.

BACKGROUND: Despite the popularity of dietary supplements, their effectiveness and safety in patients with diabetes remain controversial. Furthermore, evidence from clinical trials may not be generalizable to real-world settings. This study examined the association between dietary supplement use and mortality outcomes among patients with diabetes based on a nationally representative sample of US adults. METHODS: This study analyzed data from National Health and Nutrition Examination Survey (NHANES) 1999-2018. Supplement users referred to adults with diabetes who reported the use of any dietary supplements in the last 30 days, and with a cumulative duration of ≥ 90 days. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between supplement use and all-cause mortality, and mortality from cardiovascular diseases (CVD), diabetes, and cancer. Subgroup analysis of different supplement classes (vitamins, minerals, botanicals, amino acids, fatty acids, probiotics and glucosamine) were also conducted. RESULTS: We included 8,122 adults with diabetes (mean age: 59.4 years; 48.7% female), of whom 3,997 (54.0%) reported using supplements regularly. Vitamins (87.3%), minerals (75.3%) and botanicals (51.8%) were the most popular supplements. At a median follow-up of 6.9 years, 2447 all-cause deaths had occurred. Overall supplement use was not associated with risk of all-cause mortality among patients with diabetes (HR = 0.97, 95% CI: 0.87 to 1.08, P = 0.56). Subgroup analyses suggested that amino acid use was associated with a lower all-cause mortality (HR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), while the use of fatty acids (HR = 0.62, 95% CI: 0.42 to 0.92, P = 0.018) and glucosamine (HR = 0.69, 95% CI: 0.51 to 0.95, P = 0.022) supplements were significantly associated with lower CVD mortality. CONCLUSIONS: Our results derived from real-world data suggested that overall supplement use was not associated with any mortality benefit in patients with diabetes. However, there is preliminary evidence that suggests a protective effect of amino acid use on all-cause mortality, and a benefit of fatty acids and glucosamine supplement use on CVD mortality. Future large-scale longitudinal studies are needed to investigate the association between dietary supplement use and other intermediate diabetes-related outcomes, such as glucose control and reducing diabetes-related complications.

Impact of multicomponent integrated care on mortality and hospitalization after acute coronary syndrome: a systematic review and meta-analysis.

AIMS: Multicomponent integrated care is associated with sustained control of multiple cardiometabolic risk factors among patients with type 2 diabetes. There is a lack of data in patients with acute coronary syndrome (ACS). We aimed to examine its efficacy on mortality and hospitalization outcomes among patients with ACS in outpatient settings. METHODS AND RESULTS: A literature search was conducted on PubMed, EMBASE, Ovid, and Cochrane library databases for randomized controlled trials, published in English language between January 1980 and November 2020. Multicomponent integrated care defined as two or more quality improvement strategies targeting different domains (the healthcare system, healthcare providers, and patients) for one month or more. The study outcomes were all-cause and cardiovascular-related mortality, hospitalization, and emergency department visits. We pooled the risk ratio (RR) with 95% confidence interval (CI) for the association between multicomponent integrated care and study outcomes using the Mantel-Haenszel test. 74 trials (n = 93 278 patients with ACS) were eligible. The most common quality improvement strategies were team change (83.8%), patient education (62.2%), and facilitated patient-provider relay (54.1%). Compared with usual care, multicomponent integrated care was associated with reduced risks for all-cause mortality (RR 0.83, 95% CI 0.77-0.90; P < 0.001; I2 = 0%), cardiovascular mortality (RR 0.81, 95% CI 0.73-0.89; P < 0.001; I2 = 24%) and all-cause hospitalization (RR 0.88, 95 % CI, 0.78-0.99; P = 0.040; I2 = 58%). The associations of multicomponent integrated care with cardiovascular-related hospitalization, emergency department visits and unplanned outpatient visits were not statistically significant. CONCLUSION: In outpatient settings, multicomponent integrated care can reduce risks for mortality and hospitalization in patients with ACS.

Cross-Sectional Association of Blood Selenium with Glycemic Biomarkers among U.S. Adults with Normoglycemia in the National Health and Nutrition Examination Survey 2013-2016.

Selenium (Se) remains to have an inconsistent relationship with glycemic biomarkers and the risk of developing type 2 diabetes (T2D). Few studies have investigated the relationship between blood Se and glycemic biomarkers among people with normoglycemia. We conducted a cross-sectional analysis using the U.S. National Health and Nutrition Examination Survey 2013-2016. Multivariable linear regression models were developed to examine the associations of blood Se with glycemic biomarkers, namely, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), insulin, and the oral glucose tolerance test (OGTT). Blood Se was treated as continuous (per log-10 increment) and categorical exposure (in quartiles) in separate regression models. We assessed the dose-response relationships by restricted cubic spline analysis. After excluding the participants with T2D or incomplete data, 2706 participants were analyzed. The highest quartile of blood Se was associated with increased FPG [adjusted ß = 0.12, 95% Confidence Intervals (CI) = 0.04, 0.20], OGTT (adjusted ß = 0.29, 95% CI = 0.02, 0.56), HbA1c (adjusted ß = 0.04, 95% CI = 0.00, 0.07), and insulin (adjusted ß = 2.50, 95% CI = 1.05, 3.95) compared with the lowest quartile. Positive associations were also observed between every log-10 increment of blood Se level and glycemic biomarkers, except for OGTT. A positive linear dose-response relationship existed between blood Se and FPG (Poverall = 0.003, Pnonlinear = 0.073) and insulin (Poverall = 0.004, Pnonlinear =0.060). BMI, age, and smoking status modified the associations of the highest quartile of Se (compared with the lowest quartile) with glycemic biomarkers. Overall, positive associations of blood Se with glycemic biomarkers were observed among U.S. adults with normoglycemia. These findings implied that people with normoglycemia need to be aware of the level of Se and other mineral intakes from diet and supplements. Further research is required to identify the mechanisms of excess Se in the progression of diabetes.

Sinomenine Hydrochloride Promotes TSHR-Dependent Redifferentiation in Papillary Thyroid Cancer.

Radioactive iodine (RAI) plays an important role in the diagnosis and treatment of papillary thyroid cancer (PTC). The curative effects of RAI therapy are not only related to radiosensitivity but also closely related to the accumulation of radionuclides in the lesion in PTC. Sinomenine hydrochloride (SH) can suppress tumor growth and increase radiosensitivity in several tumor cells, including PTC. The aim of this research was to investigate the therapeutic potential of SH on PTC cell redifferentiation. In this study, we treated BCPAP and TPC-1 cells with SH and tested the expression of thyroid differentiation-related genes. RAI uptake caused by SH-pretreatment was also evaluated. The results indicate that 4 mM SH significantly inhibited proliferation and increased the expression of the thyroid iodine-handling gene compared with the control group (p < 0.005), including the sodium/iodide symporter (NIS). Furthermore, SH also upregulated the membrane localization of NIS and RAI uptake. We further verified that upregulation of NIS was associated with the activation of the thyroid-stimulating hormone receptor (TSHR)/cyclic adenosine monophosphate (cAMP) signaling pathway. In conclusion, SH can inhibit proliferation, induce apoptosis, promote redifferentiation, and then increase the efficacy of RAI therapy in PTC cells. Thus, our results suggest that SH could be useful as an adjuvant therapy in combination with RAI therapy in PTC.

Morroniside Protects Human Granulosa Cells against H2O2-Induced Oxidative Damage by Regulating the Nrf2 and MAPK Signaling Pathways.

Morroniside is the main ingredient of Cornus officinalis and has a variety of biological activities including antioxidative effects. Ovarian granulosa cells (GCs) are responsible for regulating the development and atresia of follicles, which are susceptible to oxidative stress. In this study, we determined whether morroniside can inhibit the oxidative stress of GCs induced by hydrogen peroxide (H2O2), leading to improved oocyte quality. The oxidative damage and apoptosis of ovarian GCs cultured in vitro were induced by the addition of H2O2. After pretreatment with morroniside, the levels of ROS, MDA, and 8-OHdG in ovarian GCs were significantly decreased. Morroniside significantly upregulated p-Nrf2 and promoted the nuclear translocation of Nrf2, which transcriptionally activated antioxidant SOD and NQO1. In addition, morroniside significantly regulated the levels of apoptosis-related proteins Bax, Bcl-2, cleaved caspase-9, and cleaved caspase-3 via the p38 and JNK pathways. These results suggest that morroniside can reduce the oxidative damage and apoptosis of ovarian GCs induced by H2O2.

Identifying Effects of Urinary Metals on Type 2 Diabetes in U.S. Adults: Cross-Sectional Analysis of National Health and Nutrition Examination Survey 2011-2016.

Growing evidence supports the associations of metal exposures with risk of type 2 diabetes (T2D), but the methodological limitations overlook the complexity of relationships within the metal mixtures. We identified and estimated the single and combined effects of urinary metals and their interactions with prevalence of T2D among 3078 participants in the NHANES 2011-2016. We analyzed 15 urinary metals and identified eight metals by elastic-net regression model for further analysis of the prevalence of T2D. Bayesian kernel machine regression and the weighted quantile sum (WQS) regression models identified four metals that had greater importance in T2D, namely cobalt (Co), tin (Sn), uranium (U) and strontium (Sr). The overall OR of T2D was 1.05 (95% CI: 1.01-1.08) for the positive effects and 1.00 (95% CI: 0.98-1.02) for the negative effect in the WQS models. We observed positive (Poverall = 0.008 and Pnon-linear = 0.100 for Co, Poverall = 0.011 and Pnon-linear = 0.138 for Sn) and inverse (Poverall = 0.001, Pnon-linear = 0.209 for Sr) linear dose-response relationships with T2D by restricted cubic spline analysis. Both additive and multiplicative interactions were found in urinary Sn and Sr. In conclusion, urinary Co, Sn, U and Sr played important roles in the development of T2D. The levels of Sn might modify the effect of Sr on T2D risk.

Efficacy evaluation of acupotomy combined with platelet-rich plasma in the treatment of early and middle osteoarthritis.

OBJECTIVE: To investigate the efficacy of traditional Chinese medicine acupotomy combined with platelet-rich plasma (PRP) in the treatment of early and middle osteoarthritis. METHODS: Eighty cases of early and middle knee joint pain patients admitted in our hospital were selected in this retrospective study. They were divided into the control group and observation group according to treatment methods, with 40 cases in each group. The control group was treated with PRP, and the observation group was treated with acupotomy + PRP. Clinical response rate, visual analogue scale (VAS) pain score, Lequesne score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and SF-36 quality of life score were compared between the two groups. RESULTS: The total clinical response rate in the observation group was higher than that in control group (P<0.01). VAS pain score, knee joint WOMAC index and Lequesne score in the two groups after treatment were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). SF-36 quality of life score was significantly higher in the observation group than in the control group (all P<0.001). CONCLUSION: Acupotomy combined with PRP in the treatment of early and middle osteoarthritis can relieve pain and improve joint function, which is worthy of clinical promotion.

Effect evaluation of acupuncture combined with nerve block treatment on patients with lumbar spondylolisthesis.

OBJECTIVE: To explore the clinical effect of acupuncture combined with nerve block treatment on Grade I lumbar spondylolisthesis. METHODS: Seventy patients with Grade I lumbar spondylolisthesis were randomly divided into a control group (n=70) treated with merely nerve block and an observation group (n=70) treated with acupuncture based on the nerve block treatment in the control group. The clinical efficacy rate, pain severity evaluated by VAS (on the 3rd day and in one week after treatment), recovery of spinal functions evaluated by Oswestry Dysfunction Index (ODI) and the quality of life reflected by the 36-Item Short Form Health Survey (SF-36) were compared between the two groups. RESULTS: The overall efficacy rate (94.29% vs 77.14%, P=0.036) and SF-36 score of the observation group were higher than those of the control group (both P<0.05). The VAS and ODI scores of the two groups after treatment were decreased and the observation group had lower scores (all P<0.05). CONCLUSION: Acupuncture combined with nerve block can improve the efficacy rate of treatment of Grade I lumbar spondylolisthesis, relieve the pain of patients, restore their spinal functions and improve their quality of life, which is worthy of clinical promotion.

Selective admission policy of medical undergraduates in western China: applicants' real attitudes to the choice of a rural medical career.

INTRODUCTION: Since 2010, the Chinese government has been introducing selective admission policy to recruit rural students for 5-year western medicine and traditional Chinese medicine undergraduate education in order to improve rural townships' medical services system in western China. This study aimed to analyse the selective admission policy in western China from the perspective of medical students' attitudes towards rural career choice. METHODS: A cross-sectional survey was conducted and an anonymous questionnaire was used to investigate a sample of medical undergraduates chosen under the selective admission policy. RESULTS: The results indicate that medical undergraduates' enthusiasm to work in rural areas was very limited in Gansu province, western China. Extrinsic motivation played a more important role in rural career choice than intrinsic motivation. The students' attitudes were affected by socioeconomic and cultural conditions, which determined their personal and professional environment. Course major and family economic conditions were associated with their self-decisions. CONCLUSION: Further educational intervention should emphasise the students' humanistic inner qualities and recognition of professional value. Further policy adjustment should considered, for example improving social policy-based regional character and national development strategies.