[Ontologies Applied in Clinical Decision Support Systems for Diabetes].

A clinical decision support system (CDSS) integrated with electronic health records helps physicians at the grassroots make patient-appropriate and evidence-based treatment decisions and improves the efficiency of diagnosis and treatment. Furthermore, using ontologies to build up the medical knowledge base and patient data for CDSS enhances the automation and transparency of the reasoning process of CDSS and helps generate interpretable and accurate treatment recommendations. Herein, we reviewed the relevant ontologies in the field of diabetes treatment and the progress and challenges concerning ontology-based CDSSs. Firstly, we elaborated on the current status and challenges of diabetes treatment in China, highlighting the urgent need to improve the efficiency and quality of medical services. Then, we presented background information about ontologies and gave an overview of the framework, methodology, and features of using ontologies to construct CDSS. After that, we reviewed the ontologies and instances of ontology-based CDSS in the field of diabetes treatment in China and abroad and summarized their construction methods and features. Last but not the least, we discussed the future prospects of the field, suggesting that integrating evidence-based medicine with ontologies to build a reliable clinical recommendation system should be the current focus of CDSS development.

Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital.

BACKGROUND: Recent cardiovascular outcome trials (CVOTs) changed the therapeutic strategy of guidelines for type 2 diabetes. We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials. METHODS: This electronic medical record (EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1, 2011, to June 30, 2019. We identified patients meeting the inclusion criteria of a pragmatic randomized trial (EMPA-REG OUTCOME) based on EMRs and compared their baseline characteristics with those of the trial participants. The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation. RESULTS: We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389 (17.4%) inpatients and 2646 (7.2%) outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial. Compared with the trial population, the real-world inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age, blood pressure, and lipid profiles but comprised of fewer males, metformin users, anti-hypertensive drug users, and aspirin users, and had a lower body mass index. The group of outpatients meeting the eligibility criteria had fewer males, similar age, fewer metformin users, fewer insulin users, fewer anti-hypertensive drug users, and fewer aspirin users compared with the trial population. CONCLUSIONS: The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center. Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.

[Application Value of American Urological Association Symptom Index Score in Female Patients with Type 2 Diabetic Neurogenic Bladder].

OBJECTIVE: To explore the application value of American Urological Association symptom index (AUA-SI) score in female patients of type 2 diabetes mellitus with neurogenic bladder. METHODS: This study included 289 female patients with type 2 diabetes who were hospitalized in our hospital from July 2015 to July 2018. To each of them, residual urine volume (RUV) test, fundus test, and random urinary albumin creatinine ratio (UACR) test were performed, and a questionnaire survey was conducted using AUA-SI scale. Multivariate logistic regression was used to analyze the risk factors of diabetic neurogenic bladder (DNB) in women with type 2 diabetes.RUV≥100 mL was used as the diagnostic golden standard for DNB, and the patients were divided into DNB group and non-DNP group. The ROC curve was used to evaluate the diagnostic performance of AUA-SI. Linear regression was used to test the linear trend of AUA-SI score with diabetic retinopathy stage and diabetic nephropathy stage. RESULTS: The levels of the fasting plasma glucose, hemoglobin A1c (HbA1c) and AUA-SI score in DNP group were higher than those in non-DNP group (P < 0.001). Multivariate logistic regression analysis showed that AUA-SI score had the greatest predictive value for the occurrence of DNB 〔odds ratio (OR)=1.876, P < 0.001〕.The area under the curve (AUC) was 0.843, P=0.000, 95% confidence interval (CI) (0.799, 0.888). The optimal diagnostic threshold was 7.5, the corresponding sensitivity was 0.747, and the specificity was 0.822. There was a positive correlation between the severity of AUA-SI score and the stage of diabetic retinopathy and diabetic nephropathy (P < 0.01). CONCLUSION: AUA-SI score can be used to screen female patients with DNB, while it seems parallel to the severity of DNP, diabetic retinopathy and diabetic nephropathy.

[Precision Medicine in Obesity Research and Practice].

Obesity now already becomes a critical health problem in our country and the world. Since the genomic and biochemical technology has developed in the era of precision medicine, great progression has been achieved in the field of obesity research and clinical practice. Obesity is considered to be a series of diseases with high heterogeneity beyond expectations, which brings up the challenges on its diagnosis and classification. Predictive models for obesity remain absent in clinical practice and commercial use. It is important to further understand the roles of gastric hormones and related molecules, proteins in feeding and reward system, as well as gut microbiota in obesity and associated diseases. The diagnosis and treatment of obesity require further progression in molecular biology and genetics with fruitful investigation of precision medicine, which might help the clinical translation in future.

[Obesity and Osteoporosis in Men Aged Above 50].

OBJECTIVES: To investigate the association between obesity and osteoporosis in men aged above 50 in Chengdu. METHODS: Male participants aged above 50 were recruited from those who visited West China Hospital of Sichuan University for health examinations. Bone mineral density was measured by MetriScan Bone Densitometry. The participants were divided into three groups according to T values: normal, osteopenia and osteoporosis. RESULTS: About 5.75% (525 cases) of the 9 135 male participants had osteoporosis. The three groups had significant different anthropometric parameters, including body mass, waist circumference, hip circumference, body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI)( P<0.01). The participants with the highest quartile (Q4) of BMI, BRI, WHtR, WHR, ABSI, waist circumference and height had an age-adjusted odds ratios (OR) of 0.443 [95% confidence interval ( CI): 0.342-0.574), 0.580 (95% CI: 0.454-0.740), 0.587 (95% CI: 0.460-0.751), 0.664 (95% CI: 0.516-0.854], 1.369 (95% CI: 1.069-1.751), 0.634 (95% CI: 0.497-0.809), and 1.357 (95% CI: 1.047-1.758), respectively, for osteoporosis compared with those with the lowest quartile (Q1). The area under cures (AUC) of receiver operator characteristic (ROC) curve of BMI for osteoporosis was 0.606 (95% CI:0.580-0.632). CONCLUSIONS: Large body mass was negatively associated with osteoporosis in middle and old aged men. BMI is the strongest predictor of osteoporosis. Further longitudinal studies are required to verify such asscoiations.

[The Preliminary Investigation of GLP-1 Receptor Agonist on Liver Steatosis in Obese Mice].

OBJECTIVES: To investigate the effects of glucagon-like peptide-1 (GLP-1) receptor agonist, exenatide, on liver function and steatosis in obese mice. METHODS: Male c57BL/6J mice (8 weeks old) were divided into high-fat-diet group (for obesity model construction) and chow diet group. 12 weeks later, mice of high-fat diet group were randomly divided into high-dose exenatide group [H group, intraperitoneal injection 0.02 µg/ (g·d) , high-fat-diet], low-dose exenatide group [L group, intraperitoneal injection 0.01 µg/ (g·d) , high-fat-diet], saline group (NS group, intraperitoneal injection of saline, high-fat-diet) , diet control group (D group, shifted to chow diet) and high-fat control group (M group, high-fat-diet) for 4-week treatments , respectively. The body mass and serum biochemical indicators of were detected. Liver tissues were stained with HE, and steatosis score was measured. RESULTS: After 4-week treatments, H group showed more body mass loss than L group and D group ( P<0.05). The serum alanine aminotransferase (ALT) level of NG group was higher than that of H, L, M, and NS groups ( P<0.05). Serum cholesterol and triglyceride declined to normal levels by diet intervention or drug treatment. High-dose exenatide treatment ran a risk of increasing serum uric acid level. The serum levels of aspartate aminotransferase (AST), glucose, homeostasis model assessment-insulin resistance (HOMA-IR), lipase, and amylase had no significant differences between groups (P>0.05). Hepatic steatosis score was reduced by diet intervention or drug treatment. CONCLUSIONS: High-dose exenatide treatment can effectively reduce body mass of obese mice, but it has little difference when compared with dietary intervention in improving blood fat and liver steatosis.

[Obesity and Bone Mineral Density in Menopausal Women].

OBJECTIVES: To determine the association between obesity and bone mineral density in menopausal women. METHODS: We recruited menopausal women aged 50 years and older who undertook health examinations in West China Hospital of Sichuan University in this study. Bone mineral density of the participants was measured by MetriScan Bone Densitometry. The participants were categorized into three groups according to the T value: normal density, osteopenia and osteoporosis. RESULTS: Of the 4 938 participants, 8.55% had obesity [body mass index (BMI)>28 kg/m2]. The three groups of participants were different in BMI, a body shape index (ABSI), body mass, waist circumference, hip circumference and height ( P<0.01). The age-adjusted T values were positively correlated with height, body mass, waist circumference, hip circumference, waist-hip ratio (WHR), waist-height ratio (WHtR) and body roundness index (BRI) ( P<0.05). The areas under curves (AUC) of receiver operator characteristic (ROC) were 0.540 and 0.568, respectively, for waist circumference and BMI in those with osteoporosis. CONCLUSIONS: Obesity in menopausal women is negatively associated with osteoporosis. The clinical significance of such an association requires further studies with a longitudinal design.

Autoimmune pancreatitis characterized by predominant CD8+ T lymphocyte infiltration.

Autoimmune pancreatitis (AIP) is a rare form of pancreatitis characterized by prominent lymphocyte infiltration and pancreatic fibrosis resulting in organ dysfunction. The pathogenesis and pathology of AIP remain unknown. A 64-year-old Chinese man presented with symptoms and signs of bile duct obstruction diffuse enlargement of the head of pancreas, elevated IgG levels, and negative autoimmune antibody responses. A pylorus-preserving pancreatoduodenectomy was performed and a pancreatic tumor was suspected. However, periductal lymphoplasmacytic infiltration and fibrosis were found in the head of pancreas and nearby organs instead of tumor cells. Four months after surgery, the patient was readmitted because of reoccurrence of severe jaundice and sustained abdominal distension. Prednisone 30 mg/d was administered orally as an AIP was suspected. One and a half months later, the symptoms of the patient disappeared, and globulin, aminotransferase and bilirubin levels decreased significantly. Over a 9-mo follow-up period, the dose of prednisone was gradually decreased to 10 mg/d and the patient remained in good condition. We further demonstrated dominant CD3+/CD8+ populations, CD20+ cells and a few CD4+ cells in the pancreatic parenchyma, duodenum and gallbladder wall by immunohistochemical assay. This AIP case presented with significant CD8+ T lymphocyte infiltration in the pancreas and extra-pancreatic lesions, indicating that this cell population may be more important in mediating AIP pathogenesis than previously known and that AIP might be a poorly defined autoimmune disease with heterogeneous pathogenesis.