Balancing act: The dilemma of rapid hyperglycemia correction in diabetes management.

The global diabetes surge poses a critical public health challenge, emphasizing the need for effective glycemic control. However, rapid correction of chronic hyperglycemia can unexpectedly trigger microvascular complications, necessitating a reevaluation of the speed and intensity of glycemic correction. Theories suggest swift blood sugar reductions may cause inflammation, oxidative stress, and neurovascular changes, resulting in complications. Healthcare providers should cautiously approach aggressive glycemic control, especially in long-standing, poorly controlled diabetes. Preventing and managing these complications requires a personalized, comprehensive approach with education, monitoring, and interdisciplinary care. Diabetes management must balance short and long-term goals, prioritizing overall well-being. This editorial underscores the need for a personalized, nuanced approach, focusing on equilibrium between glycemic control and avoiding overcorrection.

Elucidating the cardioprotective mechanisms of sodium-glucose cotransporter-2 inhibitors beyond glycemic control.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a pivotal intervention in diabetes management, offering significant cardiovascular benefits. Empagliflozin, in particular, has demonstrated cardioprotective effects beyond its glucose-lowering action, reducing heart failure hospitalizations and improving cardiac function. Of note, the cardioprotective mechanisms appear to be inde-pendent of glucose lowering, possibly mediated through several mechanisms involving shifts in cardiac metabolism and anti-fibrotic, anti-inflammatory, and anti-oxidative pathways. This editorial summarizes the multifaceted cardiovascular advantages of SGLT2 inhibitors, highlighting the need for further research to elucidate their full therapeutic potential in cardiac care.

The Best Strategy for the Black Hole Phenomenon between Intravascular Ultrasound and Optical Coherence Tomography.

The black hole (BH) phenomenon is an intraluminal restenotic lesion. It was identified by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) after intracoronary brachytherapy and drug-eluting stent implantation. Despite the similarity in the mode of action of brachytherapy and drug-eluting stent implantation, the BH phenomenon appears to be uncommon after drug-eluting stent implantation. Specifically, the BH phenomenon is better identified by OCT than by IVUS. Herein, we present a case of in-stent restenosis with suspected BH phenomenon on IVUS and confirmed by OCT.

Novel HNF1A gene mutation in maturity-onset diabetes of the young: A case report.

BACKGROUND: Maturity-onset diabetes of the young 3 (MODY3), caused by mutations in the HNF1A gene, is the most common subtype of MODY. The diagnosis of MODY3 is critical because a low dose of sulfonylurea agents can achieve glucose control. CASE SUMMARY: We describe a patient with MODY3 involving a novel splicing mutation, in whom low-dose gliclazide was sufficient to control clinically significant hyperglycemia. Sanger sequencing identified a splicing HNF1A mutation in 12q24 NM_000545.5 Intron5 c.1108-1G>A. Glycemic control has been maintained without insulin therapy for 28 mo after the diagnosis of diabetes. CONCLUSION: This case report highlights a novel HNF1A gene mutation in MODY3 that is responsive to sulfonylurea therapy.

Comprehensive overview of human serum albumin glycation in diabetes mellitus.

The presence of excess glucose in blood is regarded as a sweet hurt for patients with diabetes. Human serum albumin (HSA) is the most abundant protein in human plasma, which undergoes severe non-enzymatic glycation with glucose in patients with diabetes; this modifies the structure and function of HSA. Furthermore, the advanced glycation end products produced by glycated HSA can cause pathological damage to the human body through various signaling pathways, eventually leading to complications of diabetes. Many potential glycation sites on HSA have different degrees of sensitivity to glucose concentration. This review provides a comprehensive assessment of the in vivo glycation sites of HSA; it also discusses the effects of glycation on the structure and function of HSA. Moreover, it addresses the relationship between HSA glycation and diabetes complications. Finally, it focuses on the value of non-enzymatic glycation of HSA in diabetes-related clinical applications.

Relationship between serum Dickkopf-1 and albuminuria in patients with type 2 diabetes.

BACKGROUND: Diabetic kidney disease is a microvascular complication of diabetes with complex pathogenesis. Wingless signaling-mediated renal fibrosis is associated with diabetic kidney disease. Dickkopf-1, a negative regulator of Wingless, has been proven to participate in renal fibrosis, glucose metabolism, and inflammation. However, whether serum Dickkopf-1 levels are associated with diabetic kidney disease remains unclear. AIM: To assess the relationship between serum Dickkopf-1 levels and albuminuria in individuals with type 2 diabetes. METHODS: Seventy-three type 2 diabetes patients and 24 healthy individuals were enrolled in this case-control study. Diabetic individuals were separated into normal albuminuria, microalbuminuria, and macroalbuminuria groups based on their urinary albumin/creatinine ratios (UACRs). Clinical characteristics and metabolic indices were recorded. Serum Dickkopf-1 levels were determined by enzyme-linked immunosorbent assay. RESULTS: No significant difference in serum Dickkopf-1 levels was found between healthy individuals and the normal albuminuria group. However, the levels in the microalbuminuria group were significantly lower than those in the normal albuminuria group (P = 0.017), and those in the macroalbuminuria group were the lowest. Bivariate analysis revealed that serum Dickkopf-1 levels were positively correlated with hemoglobin A1c level (r = 0.368, P < 0.01) and estimated glomerular filtration rate (r = 0.339, P < 0.01), but negatively correlated with diabetes duration (r = -0.231, P = 0.050), systolic blood pressure (r = -0.369, P = 0.001), serum creatinine level (r = -0.325, P < 0.01), and UACR (r = -0.459, P < 0.01). Multiple and logistic regression showed that serum Dickkopf-1 levels were independently associated with UACR (odds ratio = 0.627, P = 0.021). CONCLUSION: Serum Dickkopf-1 levels are negatively associated with UACR. Lower serum Dickkopf-1 levels could be a critical risk factor for albuminuria in diabetes.

Association between serum Sestrin2 level and diabetic peripheral neuropathy in type 2 diabetic patients.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is a chronic and serious microvascular complication of diabetes linked to redox imbalance. Sestrin2, a novel inducible stress protein, participates in glucose metabolic regulation and redox homeostasis. However, the association between serum Sestrin2 and DPN is unknown. AIM: To explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 96 T2DM patients and 39 healthy volunteers, matched by age and sex, participated in this cross-sectional study. Clinical features and metabolic indices were identified. Serum Sestrin2 was measured by ELISA. The association between Sestrin2 and DPN was studied. Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN. RESULTS: The 96 patients with T2DM were divided into DPN (n = 47) and patients without DPN (n = 49). Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined [9.10 (5.41-13.53) ng/mL vs 12.75 (7.44-23.80) ng/mL, P < 0.01]. T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers [14.58 (7.93-26.62) ng/mL vs 9.10 (5.41-13.53) ng/mL, P < 0.01]. However, T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN [9.86 (6.72-21.71) ng/mL vs 14.58 (7.93-26.62) ng/mL, respectively, P < 0.01]. Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index (r = 0.672, P = 0.000), hemoglobin A1c (HbA1c) (r = 0.292, P = 0.000), serum creatinine (r = 0.206, P = 0.016), triglycerides (r = 0.731, P = 0.000), and fasting glucose (r = 0.202, P = 0.040), and negatively associated with estimated glomerular filtration rate (r = -0.230, P = 0.007). After adjustment for sex, age, HbA1c, and diabetes duration, multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels (P = 0.000). Logistic regression analyses indicated that Sestrin2, diabetes duration, and high-density lipoprotein were strongly associated with DPN (odds ratio = 0.855, 1.411, and 0.041, respectively). CONCLUSION: Our results show Sestrin2 is decreased in T2DM patients with DNP. As lower Sestrin2 is independently associated with DPN, Sestrin2 may contribute to progression of DPN in T2DM patients.

Numerical evaluation and experimental validation of vascular access stenosis estimation.

Vascular access dysfunction commonly occurs in hemodialysis patients. Regularly monitoring and evaluating the vascular access condition is an important issue for these diseased patients. The objective of this study was to identify acoustic parameters and hemodynamics that related to changes in the stenosis of vascular access. In-vitro experimental circulation system offered pulsatile and physiological condition to simulate the arteriovenouse access in hemodialysis patient. We created the environments of various degrees of stenosis (DOS) inside the arteriovenouse access to simulate the stenotic conditions in patients. And we also used the computational fluid dynamics (CFD) to simulate the pressure distribution, primary axial velocity distribution, and secondary flow distribution in the same various DOS and boundary condition. There are two findings, one is recorded the bruit which caused by the fluctuation of fluid in different severe stenosis, the other is described the correlation between bruit and hemodynamic parameters. Experimental results show the time constants have linear regression with a positive correlation as the degree of stenosis (DOS) increases. Finally, in contrast to CFD computerized analysis and acoustic methods, the proposed parameter provides a feasibility index for evaluating the risk of AVG dysfunction in on-line/real time analysis.

Polymer crystallization dynamics investigated by synchronous scanning spectrum.

There is a cosine function between the reflected light intensity of a solid surface and its refractive index. And the mean squared fluctuation of refractive index is related to fluctuation of density and concentration. So some internal structures changes of materials can be reflected by changes in reflected light. Based on this theory, the synchronous scanning spectrum (SSS) technique was successfully applied to monitor melting and nonisothermal melt-crystallization of poly(ε-caprolactone) (PCL) film on a copper substrate. SSS can be implemented on a spectrofluorimeter by simultaneously scanning the excitation and emission monochromators (i. e, Δλ = λex-λem = 0 nm). In SSS of PCL films, two dominant peaks correlated to the light source spectrum of the spectrofluorimeter (at 467 and 473 nm) were used to characterize the macromolecular structure evolution during the melting and nonisothermal melt-crystallization processes. Detailed thermodynamic and crystallization kinetics parameters obtained by SSS method. The Avrami exponent n obtained by SSS method is in the range of 2.8-3.2 with an average of 3.13, illustrating a heterogeneous nucleation process followed by a three-dimensional spherulitic crystal growth mechanism. The crystallization activation energy is -158.2 kJ · mol(-1). These results are in agreement with values determined from differential scanning calorimetry (DSC) method. It indicates that SSS technique is a simple, effective in situ method for measuring the dynamic melting and crystallization process of polymers. Moreover, the SSS method is a universal spectroscopic technique based on a spectrofluorimeter for monitoring both luminescent and non-luminous solid polymers.

[Cochlear implant performance evaluation with cortical auditory evoked potential in a group of post-lingually deaf adults].

OBJECTIVE: To investigate the law of auditory remodeling by studying the Cortical Auditory Evoked Potential in a group of post-lingually deaf adults in the early stage of the cochlear implant use. METHOD: Ten post-lingually deaf adults implanted with PULSAR ci 100 of Medel device ranged from 19 to 52 years old with duration of deafness from 3 months to 23 years.were involved. Their P1-N1-P2 responses to /ba/ at around 60-70 dB SPi and open-set speech recognition scores of mono-syllabic words were recorded at 1. 3 and 6 months after the switch-on of cochlear implants. RESULT: Six out of 10 typical waveforms of Pl-N1-P2 were obtained. The other I were with atypical waveforms. The group with atypical waveform was characterized by long duration and early onset of deafness. There was no significant difference regarding either the amplitude or the latency of each peak at the 3 data collection time points. There was significant difference among the 3 data collection time points about the speech recognition scores with the highest score at the 6th month of switch on. There was no significant correlation between the peak of the CAEP and speech recognition score. CONCLUSION: In the first 6 months of cochlear implant use in the post-lingually deaf adults, the duration and the onset age of deafness played important role in respect of the presence and waveform morphology of the CAEPs. It needs at least 6 months for the central auditory system to make use of the audio input from the cochlear implant.

Preparation and characterization of cationic chitosan-modified poly(D,L-lactide-co-glycolide) copolymer nanospheres as DNA carriers.

Chitosan (CS)-modified poly(D,L-lactide-co-glycolide) (PLGA/CS) nanoparticles with cationic surface were prepared by means of emulsion-solvent evaporation technique using polyviny alcohol and chitosan as costabilizers. The preparation conditions of the cationic nanoparticles were optimized by orthogonal factorial design, and the influences of the experiment variables such as polymer concentration, the molecular weight of chitosan, etc., on the size and zeta potential of the nanoparticles were evaluated. It was shown that the diameter of the PLGA/CS nanoparticles can be controlled in the range of 150-200 nm as determined by dynamic light scattering with the optimized conditions. The zeta potential of PLGA/CS nanoparticles increased with increasing the concentration of CS (C(CS)) or decreasing the pH, it was up to 55 mV when C(CS) was 3 mg/mL at pH 4 and inversed around pH 8. The optimization conditions for fabricating the relatively small diameter and high zeta potential cationic nanoparticles were C(CS) 3 mg/mL, C(PLGA) 10 mg/mL, and the volume ratio of organic solution to aqueous medium 1/4. X-ray photo electron spectroscopy and fluorescence inverted microscope observations approved that CS molecules were adsorbed on the surface of PLGA nanoparticles, DNA-condensing ability of the PLGA/CS nanoparticles and cell transfection efficiency of the nanoparticle-DNA complexes were estimated by gel electrophoresis and transfection experiment to 293FT cell, respectively.

[Infants hearing screening in the coastal villages of Shandong province].

OBJECTIVE: To study how to perform the hearing screening on the infants in the rural area. METHODS: Three thousand nine hundreds and twenty-two infants, about 84% of them from rural, were born in the People Hospital of LaiZhou City from January to December in 2004. The infants were performed fast hearing screening by transient evoked otoacoustic emission (TEOAE) after the birth in 2-7 days. The fail cases were checked again after 4-6 weeks, and then were diagnosed if they still failed after following-up. RESULTS: The infants (3612/3922, 92.1%) have been checked by TEOAE, and the examination was free in the poverty cases. The rate passed on the first check was 69.96% (2527/3922), but 1085 infants failed (30.4%), while 310 infants have not been checked (7.9%). In the 1085 cases that should be rechecked, there was only 633 cases (58.34%) accepted the check on time, while 452 cases (41.66%) missed. In the 163 cases with high-risk infants in 2004, 114 infants (69.96%) were checked, but 49 infants (29.04%) were not checked. Fourteen cases failed in the recheck, and 11 of them were checked by ABR. Two cases were found to be moderate and severe hearing loss in binaural respectively and 4 cases with mild hearing loss in monaural while 3 cases were normal. CONCLUSIONS: It is necessary and viable for the infants on hearing screening in the rural area It should be set up and perfected the model for infants on hearing screening in rural area as soon as possible; it should be free for the poor infants to make sure everyone enjoy the health care.

Diagnosis and treatment of jugular foramen neurinomas / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical features and treatments of jugular foramen neurinomas. The approximate approach and proper exposure regions of jugular foramen tumour were discussed in this paper.</p><p><b>METHODS</b>Fourteen cases of jugular foramen neurinomas were diagnosed by CT, MRI, DSA and 3D-CT reconstruction preoperatively. The tumours were resected by far lateral infra-temporal approach. The classification and relative operative approaches were discussed.</p><p><b>RESULTS</b>Among 14 patients, total removal were achieved in 8 cases, subtotal removal in 4 cases and partial removal in the other 2 cases. All patients got good recovering. No serious complications correlating the approaches occurred except one case of facial paralysis.</p><p><b>CONCLUSION</b>The far later infratentorial approach was suggested to be more suitable for surgery upon neurinomas of jugular foramen.</p>