Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus.

Carotid atherosclerosis (CA) and carotid plaque (CP) are highly correlated with cardiovascular disease. We aimed to determine the prevalence of CA and CP and their relationship with 10-year risks of stroke and coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM).We studied 1584 T2DM patients aged 20 years and older. CA and CP were detected using ultrasonography. Ten-year stroke and CHD risk were determined using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine.The prevalence of CA and CP increased gradually with age. Men had a higher prevalence of CA than women (CA: 58.18% vs 51.54%, P < .01). The 10-year CHD risk (27.9% vs 15.4%, P < .001) and stroke risk (15.2% vs 5.70%, P < .001) were higher in patients with CA than that of those without CA. Compared with patients without CA, the odds ratios (ORs) of CHD in CA and CP group were 4.47 and 10.78 for men, and 4.19 and 5.20 for women, respectively; in the case of stroke, the OR in CA and CP group were 8.83 and 12.07 for men, and 4.35 and 4.90 for women, respectively (P < .001 for all). Multivariate binary logistic regression analysis showed that CA was an independent risk factor for CHD [OR = 2.66, 95% confidence interval (95% CI), 2.05-3.46, P < .001] and stroke (OR = 3.11, 95% CI, 2.38-4.07, P < .001).CA and CP were prevalent in patients with T2DM and positively correlated with 10-year CHD and stroke risk. CA was an independent risk factor for 10-year CHD risk.

Lower Extremity Peripheral Arterial Disease Is an Independent Predictor of Coronary Heart Disease and Stroke Risks in Patients with Type 2 Diabetes Mellitus in China.

We aimed to determine the relationship between lower extremity peripheral arterial disease (PAD), 10-year coronary heart disease (CHD), and stroke risks in patients with type 2 diabetes (T2DM) using the UKPDS risk engine. We enrolled 1178 hospitalized T2DM patients. The patients were divided into a lower extremity PAD group (ankle-brachial index ≤ 0.9 or >1.4; 88 patients, 7.5%) and a non-PAD group (ankle-brachial index > 0.9 and ≤1.4; 1090 patients, 92.5%). Age; duration of diabetes; systolic blood pressure; the hypertension rate; the use of hypertension drugs, ACEI /ARB, statins; CHD risk; fatal CHD risk; stroke risk; and fatal stroke risk were significantly higher in the PAD group than in the non-PAD group (P < 0.05 for all). Logistic stepwise regression analysis indicated that ABI was an independent predictor of 10-year CHD and stroke risks in T2DM patients. Compared with those in the T2DM non-PAD group, the odds ratios (ORs) for CHD and stroke risk were 3.6 (95% confidence interval (CI), 2.2-6.0; P < 0.001) and 6.9 (95% CI, 4.0-11.8; P < 0.001) in those with lower extremity PAD, respectively. In conclusion, lower extremity PAD increased coronary heart disease and stroke risks in T2DM.

Association of Chronic Kidney Disease with Coronary Heart Disease and Stroke Risks in Patients with Type 2 Diabetes Mellitus: An Observational Cross-sectional Study in Hangzhou, China.

BACKGROUND: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). However, the association between CKD and CVD risk in patients with type 2 diabetes mellitus (T2DM) in China has not yet been well investigated. This study aimed to determine the association of CKD with the risks of coronary heart disease (CHD) and stroke in a Chinese population with T2DM. METHODS: A total of 1401 inpatients with T2DM at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2008 and November 2013 were included in this study. The CKD-Epidemiology Collaboration equation for Asians was used to classify CKD. The UK Prospective Diabetes Study risk engine was used to estimate the risks of CHD and stroke. RESULTS: CHD risk was significantly increased with CKD stage (20.1%, 24.8%, and 34.3% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P < 0.001 for all). The stroke risk was also increased with CKD stage (8.6%, 12.7%, and 25.4% in T2DM patients with no CKD, CKD Stage 1-2, and Stage 3-5, respectively; P < 0.001 for all). Compared with no-CKD group, the odds ratios (OR s) for high CHD risk were 1.7 (P < 0.001) in the CKD Stage 1-2 group and 3.5 (P < 0.001) in the CKD Stage 3-5 group. The corresponding OR s for high stroke risk were 1.9 (P < 0.001) and 8.2 (P < 0.001), respectively. CONCLUSION: In patients with T2DM, advanced CKD stage was associated with the increased risks of CHD and stroke.

[A rare case of Silver-Russell syndrome in adult and literature review].

Silver-Russell syndrome (SRS) is a rare genetic disorder with non-specific manifestations and severity, so that the clinical diagnosis of SRS remains difficult. We reported a 23-year-old female patient with SRS characterized with short body stature, asymmetry, obesity, fifth finger clinodactyly and dislocation of hip. The patient had a past history of lengthening operation on the right lower limb at the age of 10. Chromosome analysis revealed (46, XX). The patient was admitted due to severe asymmetry in low extremities caused by right-side obesity. After successful orthopedic surgery in the right hips and thighs the symptoms of patient were relieved.

[Association of serum sex hormone-binding globulin with type 2 diabetes].

OBJECTIVE: To explore the changes of serum sex hormone-binding globulin (SHBG) and sex hormone levels in type 2 diabetes and to explore the correlation of SHBG with blood glucose, BMI, insulin sensitivity and the intervention of pioglitazone. METHODS: Eighty-five cases with type 2 diabetes (38 women) and 59 normal controls (27 women) were recruited randomly in the study. Among all patients 48 underwent pioglitazone intervention. All women were postmenopausal. Fasting serum samples were taken separately. SHBG were measured with IRMA, and estrogen (E2), testosterone (T), fasting insulin (FINS ) were detected with RIA. Body weight, fasting blood glucose (FBG), blood lipids,BMI, HOMA-IS were measured and calculated as well. LN [1/ (FBG x FINS)] was used as insulin sensitivity index (ISI). RESULT: Patient groups had lower serum SHBG levels than control groups of both sexes (women, P<0.01; men, P<0.05). T/SHBG are higher in women patient group compared with control (P<0.01). Spearman analysis showed that in women patient group,serum SHBG was correlated with FBG, FINS and ISI (r(s)=-0.372 P<0.05; 0.332 P<0.05; 0.445 P<0.01). While in men patient group,BMI was negatively correlated with serum SHBG and total T (r(s)= 0.329 P<0.05 and-0.424 P<0.01). Significant improvements of blood glucose and lipids were demonstrated in patients after 12-week pioglitazone intervention compared with baseline values, while serum SHBG, sex hormones and ISI had not significantly changed. CONCLUSION: Reduced serum SHBG of patients with type 2 diabetes might be related to insulin resistance to some extent.

[Significance and expression of vascular endothelial growth factor-C (VEGF-C) in esophageal squamous carcinoma and glioma].

BACKGROUND & OBJECTIVE: The research in recent years has demonstrated that vascular endothelial growth factor-C (VEGF-C) is expressed in certain malignant tumor cells, and up to now VEGF-C is the only growth factor specific for lymphangiogenesis. The relationship between the VEGF-C expression in malignant tumor tissues and lymphatic metastasis is still scarcely reported. This study was designed to compare the VEGF-C expression in human esophageal squamous carcinoma and glioma, and then to analyze the relationship between the VEGF-C expression and tumor lymphatic metastasis. METHODS: The expression of VEGF-C antigen was detected with immunohistochemical method in 72 human esophageal squamous carcinomas (29 cases with lymph node metastasis,43 cases without lymph node metastasis) and 23 human gliomas (diagnosed pathologically as astrocytoma in grades I to IV), followed by the further analysis on the relationship between VEGF-C expression and clinicopathological parameters. RESULTS: The expression of VEGF-C antigen was not found in any gliomas, while the positive VEGF-C expression rate achieved 38.88%(28/72) in the human squamous carcinoma, with 62.07%(18/29) in the cases with lymph node metastasis, 23.26%(10/43) in the cases without lymph node metastasis, 58.82% (20/34) in the T2 and T3 of invasion depth cases, and 21.05%(8/38)in the T1 of invasion depth cases. CONCLUSION: The expression of VEGF-C antigen was significantly associated with lymph node metastasis and invasion depth in esophageal squamous carcinoma. VEGF-C may act as a key factor in the facilitation of lymphatic metastasis in esophageal squamous carcinoma.