Cross-cultural adaptation and validation of the geriatric 8 screening tool in Chinese hospitalized older adults with cancer.

OBJECTIVES: To translate, cross-culturally adapt, and validate the Geriatric 8 (G8) questionnaire in Chinese hospitalized older adults with cancer. METHODS: The Chinese version of the G8 (C-G8) was produced following Brislin's guidelines. The psychometric properties of the C-G8 were evaluated among 296 eligible patients. RESULTS: The content validity index of the C-G8 was 0.8∼1 at the item level and 0.975 at the scale level. The C-G8 identified more frail individuals among these older (>75 years) participants compared to their younger (65∼75 years) counterparts (frailty prevalence: 87.1% vs. 70.9%, P=0.010). The convergent validity of the C-G8 was tested by correlating it with the FRAIL scale (r=-0.592, P<0.001). The C-G8 had a lower internal consistency (Cronbach's α coefficient=0.501) but higher test-retest reliability and inter-rater reliability (intraclass correlation coefficient=0.913 and 0.993, respectively, P<0.001). CONCLUSIONS: The C-G8 questionnaire presented acceptable validity and reliability and could be used in Chinese hospitalized older adults with cancer.

Left ventricular subclinical myocardial dysfunction in uncomplicated type 2 diabetes mellitus is associated with impaired myocardial perfusion: a contrast-enhanced cardiovascular magnetic resonance study.

BACKGROUND: Early detection of subclinical myocardial dysfunction in patients with diabetes mellitus (DM) is essential for recommending therapeutic interventions that can prevent or reverse heart failure, thereby improving the prognosis in such patients. This study aims to quantitatively evaluate left ventricular (LV) myocardial deformation and perfusion using cardiovascular magnetic resonance (CMR) imaging in patients with type 2 diabetes mellitus (T2DM), and to investigate the association between LV subclinical myocardial dysfunction and coronary microvascular perfusion. METHODS: We recruited 71 T2DM patients and 30 healthy individuals as controls who underwent CMR examination. The T2DM patients were subdivided into two groups, namely the newly diagnosed DM group (n = 31, patients with diabetes for ≤ 5 years) and longer-term DM group (n = 40, patients with diabetes > 5 years). LV deformation parameters, including global peak strain (PS), peak systolic strain rate, and peak diastolic strain rate (PSDR), and myocardial perfusion parameters such as upslope, time to maximum signal intensity (TTM), and max signal intensity (Max SI, were measured and compared among the three groups. Pearson's correlation was used to evaluate the correlation between LV deformation and perfusion parameters. RESULTS: Pooled data from T2DM patients showed a decrease in global longitudinal, circumferential, and radial PDSR compared to healthy individuals, apart from lower upslope. In addition, increased TTM and reduced Max SI were found in the longer-term diabetics compared to the normal subjects (p < 0.017 for all). Multivariable linear regression analysis showed that T2DM was independently associated with statistically significant CMR parameters, except for TTM (ß = 0.137, p = 0.195). Further, longitudinal PDSR was significantly associated with upslope (r = - 0.346, p = 0.003) and TTM (r = 0.515, p < 0.001). CONCLUSIONS: Our results imply that a contrast-enhanced 3.0T CMR can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion in the early stages of T2DM, and that the myocardial dysfunction is associated with impaired coronary microvascular perfusion.

Assessment of tetralogy of Fallot-associated congenital extracardiac vascular anomalies in pediatric patients using low-dose dual-source computed tomography.

BACKGROUND: To investigate the diagnostic value of dual-source computed tomography (DSCT) in the evaluation of tetralogy of Fallot (TOF)-associated extracardiac vascular abnormalities in pediatric patients compared with transthoracic echocardiography (TTE). METHODS: One hundred and twenty-three pediatric patients diagnosed with TOF were included in this retrospective study. All patients underwent DSCT and TTE preoperatively. All associated extracardiac vascular abnormalities and their percentages were recorded. The diagnostic performances of DSCT and TTE were compared based on the surgical results. The image quality of DSCT was rated, and the effective radiation dose (ED) was calculated. RESULTS: A total of 159 associated extracardiac vascular deformities were confirmed by surgery. Patent ductus arteriosus (36, 22.64%), right-sided aortic arch (29, 18.24%), and pulmonary valve stenosis (23, 14.47%) were the most common associated extracardiac vascular abnormalities. DSCT was superior to TTE in demonstrating associated extracardiac anomalies (diagnostic accuracy: 99.13% vs. 97.39%; sensitivity: 92.45% vs. 77.07%; specificity: 99.81% vs. 99.42%). The agreement on grading the image quality of DSCT was excellent (κ = 0.80), and the mean score of the image quality was 3.39 ± 0.50. The mean ED of DSCT was 0.86 ± 0.47 mSv. CONCLUSIONS: Compared to TTE, low-dose DSCT has high diagnostic accuracy in the depiction of associated extracardiac vascular anomalies in pediatric patients with TOF, and could provide more morphological details for surgeons.

Effect of "maccog" TCM tea on improving glucolipid metabolism and gut microbiota in patients with type 2 diabetes in community.

Objectives: This work aimed to observe the effect of consuming Chinese herb tea on glucolipid metabolism and gut microbiota in patients with type 2 diabetes mellitus (T2DM). Methods: Ninety patients with T2DM were recruited from a community and randomly divided into the control group (CG) and intervention group (IG). CG maintained conventional treatment and lifestyle, and IG accepted additional "maccog" traditional Chinese medicine (TCM) tea (mulberry leaf, radix astragali, corn stigma, cortex lycii, radix ophiopogonis, and gynostemma) for 12 weeks. Glucolipid metabolism, hepatorenal function, and gut microbiota were then measured. Results: After the intervention, the decreases in fasting plasma glucose (FPG) and total cholesterol (TC) were greater (P<0.05) in IG than in CG, and those in glycosylated serum protein (GSP) were almost significantly greater (P=0.066) in IG than in CG. The total protein (TP), albumin (ALB), and creatinine (CREA) levels in IG were significantly lower and their decreases were larger in IG than in CG (P<0.05) after the intervention. The Ace and Chao1 indices in IG were slightly higher after the intervention (P=0.056 and 0.052, respectively) than at baselines. The abundance of Actinobacteria, Lachnospiraceae, Bifidobacteriaceae, and Phascolarctobacterium increased significantly after the intervention in IG (P<0.05), and the abundance was higher in IG than in CG (P<0.05 or P<0.1). The abundance of Clostridiales and Lactobacillales was negatively correlated with FPG (P<0.05), Clostridiales and Lachnospiraceae was negatively correlated with GSP (P<0.05), and Bacteroides/Firmicutes was positively correlated with both (P<0.05). No adverse event was observed during the intervention. Conclusions: Administration of "maccog" TCM tea for 12 weeks slightly improved glucolipid metabolism and significantly increased the abundance of beneficial gut microbiota in community patients with T2DM. The increase in beneficial bacteria abundance may be involved in the improvement of glucose metabolism indicators. In addition, this intervention is safe and feasible. Clinical trial registration: https://www.chictr.org.cn/showproj.aspx?proj=31281, identifier ChiCTR1800018566.

Exercise Combined with a Chinese Medicine Herbal Tea for Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

Objectives: Exercise and Traditional Chinese Medicine (TCM) herbal tea may improve glucose metabolism through quite different mechanisms while sharing some common effects. The purpose of this study was to discover whether the intervention of exercise combined with TCM herbal tea intervention could produce advanced improvement in glucose metabolism than exercise alone in community patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This was a 12-week, randomized controlled trial in which 75 community patients with T2DM were randomly assigned to the single group (n = 39) receiving intervention of aerobic and resistance exercise three times per week and the combined group (n = 36) receiving intervention of TCM herbal tea (consisted of six substances) taken once daily besides the exercise. The change of glycated hemoglobin A1 (HbA1c), tested before and after intervention, served as the primary outcome. Other measurements include fasting plasma glucose (FPG), glycated serum protein (GSP), lipid profile, and physical fitness profile. Results: HbA1c and FPG levels and their changes showed no group difference. The level of GSP was lower, and its decrease was also larger after exercise combined with TCM herbal tea than after single exercise intervention (p < 0.05). Lipid profile and physical fitness parameters were similar in the two groups except the larger six-minute walk test (6MWT) power after the combined intervention (p < 0.05). Patients showed good compliance with the intervention and had similar exercise days or amount in the two groups. No patient reported serious adverse events or significant changes in other lifestyles. Conclusions: A 12-week of exercise combined with TCM herbal tea could not enhance the hypoglycemic effects by exercise alone in community patients with type 2 diabetes. However, the lower GSP level and larger 6MWT work brought by combined intervention suggest its potential benefits, and further studies are needed to explore the effects of longer period and larger dosage of intervention. Clinical Trial Registration Number: Chinese Clinical Trial Registry: ChiCTR1800018721.

A retroperitoneal bronchogenic cyst clinically mimicking an adrenal mass: three case reports and a literature review.

Bronchogenic cysts are a congenital primitive foregut-derived developmental malformation, generally occurring in the posterior mediastinum. Their development in the retroperitoneum is extremely rare. Imaging techniques, such as multidetector computed tomography (MDCT), are typically effective in the detection of these lesions. Here, we describe three cases of a retroperitoneal cyst presenting as a para-adrenal mass. Only one boy presented with abdominal pain, and the other two showed no clinical symptoms. Endocrinological evaluation of all three cases was performed, and no adrenal hormone secretion was detected. All three cases were misdiagnosed preoperatively. Each patient underwent surgery, and one symptomatic patient became asymptomatic after surgery. Pathologic examination confirmed all three masses as bronchogenic cysts. The three cases showed some similar MDCT imaging features, including a complete adrenal structure, a cystic or solid mass in the adrenal region, and no obvious enhancement. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal masses, even though accurate preoperative diagnosis remains difficult. A contrast-enhanced MDCT scan may be useful for differentiating hyper-attenuated cysts from other soft tissue masses.

Assessment of left ventricular deformation in patients with type 2 diabetes mellitus by cardiac magnetic resonance tissue tracking.

To quantify the global and regional left ventricular (LV) myocardial strain in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) tissue-tracking techniques and to determine the ability of myocardial strain parameters to assessment the LV deformation. Our study included 98 adult T2DM patients (preserved LV ejection fraction [LVEF], 72; reduced LVEF, 26) and 35 healthy controls. Conventional LV function, volume-time curve parameters and LV remodeling index were measured using CMR. Global and regional LV myocardial strain parameters were measured using CMR tissue tracking and compared between the different sub-groups. Receiver operating characteristic analysis was used to assess the diagnostic accuracy. Regression analyses were conducted to determine the relationship between strain parameters and the LV remodeling index. The results show that global radial peak strain (PS) and circumferential PS were not significantly different between the preserved-LVEF group and control group (P > 0.05). However, longitudinal PS was significantly lower in the preserved-LVEF group than in the control group (P = 0.005). Multivariate linear and logistic regression analyses showed that global longitudinal PS was independently associated (ß = 0.385, P < 0.001) with the LV remodeling index. In conclusion, early quantitative evaluation of cardiac deformation can be successfully performed using CMR tissue tracking in T2DM patients. In addition, global longitudinal PS can complement LVEF in the assessment of cardiac function.

Selenium Levels in Community Dwellers with Type 2 Diabetes Mellitus.

Selenium (Se) is an essential micronutrient required by the human body and exerts biological functions through selenoproteins. The relationship between Se and diabetes remains ambiguous. This study aimed at, through measurements of serum selenoprotein P (SelP), glutathione peroxidase (GPx3), and Se content in serum and hair, evaluating Se levels in community dwellers with type 2 diabetes mellitus (T2DM). A total of 336 subjects, including 176 T2DM patients (65.5 ± 8.7 years old) and 160 healthy residents (63.7 ± 9.8 years old, as controls), were recruited in this cross-sectional community-based study performed in Suzhou. Samples of fasting venous blood and hair were collected for measurements of Se levels, glycometabolism, and biochemistry parameters. We found that the serum Se level and SelP concentration in T2DM patients were substantially higher than those in healthy residents (p < 0.05). There was no significant difference in GPx3 activity and hair Se level between the two groups of subjects (p > 0.05). Serum Se was positively correlated with both GPx3 and hair Se in T2DM patients (r = 0.167 and 0.164, respectively, p < 0.05) and negatively correlated with SelP in healthy controls (r = - 0.293, p < 0.05). In conclusion, this study showed significantly higher levels of serum Se and SelP in community dwellers with T2DM than in matched healthy residents.

Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Predicts Adverse Clinical Outcomes: A Cardiovascular Magnetic Resonance Feature Tracking Study.

The aim of this study was to investigate left ventricular (LV) global myocardial strain and LV involvement characteristics in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to evaluate their predictive value of adverse cardiac events. Sixty consecutive ARVD/C patients with a definite diagnosis of ARVD/C who underwent CMR examination and thirty-four healthy controls were enrolled retrospectively. The CMR images were analyzed for LV myocardial strain and the presence of LV involvement. The endpoint was defined as a composite of sustained ventricular tachycardia or fibrillation, cardiac death, resuscitated cardiac arrest, heart transplantation, and appropriate implantable cardioverter-defibrillator shock. LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were significantly impaired in ARVC/D patients compared to healthy controls (GLS: -13.89 ± 3.26% vs. -16.68 ± 2.74%, GCS: -15.65 ± 3.40% vs. -19.20 ± 2.23%, GRS: 34.57 ± 11.98% vs. 49.92 ± 12.59%; P < 0.001 for all). Even in ARVC/D patients with preserved LVEF, LV GLS, GCS and GRS were also significantly reduced than in controls. During a mean follow-up period of 4.10 ± 1.77 years, the endpoint was reached in 17 patients. LV GLS >-12.65% (HR, 3.58; 95%CI, 1.14 to 11.25; p = 0.029) and history of syncope (HR, 4.99; 95%CI, 1.88 to 13.24; p = 0.001) were the only independent predictors of cardiac outcomes. The LV myocardial deformation derived from FT CMR was significantly impaired in ARVD/C patients, and this alteration can occur before the impairment of LVEF. LV GLS >-12.65% and history of syncope were the only independent prognostic markers of adverse cardiac outcomes.

Evaluation of myocardial fibrosis in diabetes with cardiac magnetic resonance T1-mapping: Correlation with the high-level hemoglobin A1c.

AIM: The aim of the study was to assess the extracellular volume fraction (ECV) in type 2 diabetes mellitus (T2DM) patients with different level of hemoglobin A1c (HbA1c) by cardiac magnetic resonance (CMR), and the ability of HbA1c to predict myocardial fibrosis. METHODS: In total, 80 T2DM patients and 20 age- and sex-matched controls were prospective enrolled and underwent CMR to obtain ECV value and LV function parameters. We divided all patients into a group of HbA1c < 7.0% and a group of HbA1c ≥ 7.0%. RESULTS: In the higher HbA1c group the ECV value (all p < 0.001) was higher than both lower HbA1c group (36.23% vs. 32.19%, p < 0.001) and controls (36.23% vs. 29.73%, p < 0.001). HbA1c was positively associated (ß = 0.36, p = 0.004) with ECV, and it was also an independent predictor of myocardial fibrosis (OR = 2.00, P = 0.014). The ROC analysis showed that 7.1% was the optimal cutoff value of HbA1c that predicted the risk of myocardial fibrosis with high diagnostic accuracy (area under the curve = 0.78). CONCLUSION: T1 mapping provided myocardial fibrosis information in T2DM patients. HbA1c is positively correlated with myocardial fibrosis and can be an independently predictor of myocardial fibrosis, which may be helpful for the clinical decision-making of blood glucose control.

Cardiac magnetic resonance feature tracking for quantifying right ventricular deformation in type 2 diabetes mellitus patients.

To determine the feasibility of deformation analysis in the right ventricle (RV) using cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) in type 2 diabetes mellitus (T2DM) patients. We enrolled 104 T2DM patients, including 14 with impaired right ventricular ejection fraction (RVEF) and 90 with preserved RVEF, and 26 healthy controls in this prospective study. CMR was used to determine RV feature-tracking parameters. RV strain parameters were compared among the controls, patients with preserved and reduced RVEF. Binary logistic regression was used to predict RV dysfunction. Receiver operating characteristic analysis was used to assess the diagnostic accuracy. The agreement was tested by Bland-Altman analysis. Compared with controls, longitudinal and circumferential global peak strain (PS) and PS at mid-ventricular, apical slices were significantly decreased in T2DM patients with or without reduced RVEF (p < 0.05). Within the T2DM patients, the global longitudinal PS (GLPS) and the longitudinal PS at mid-ventricular segments were significantly reduced in the reduced RVEF group than in preserved RVEF groups (p < 0.05). GLPS was an independent predictor of RV dysfunction (odds ratio: 1.246, 95% CI: 1.037-1.496; p = 0.019). The GLPS demonstrated greater diagnostic accuracy (area under curve: 0.716) to predict RV dysfunction. On Bland-Altman analysis, global circumferential PS and GLPS had the best intra- and inter-observer agreement, respectively. In T2DM patients, CMR-FT could quantify RV deformation and identify subclinical RV dysfunction in those with normal RVEF. Further, RV strain parameters are potential predictors for RV dysfunction in T2DM patients.