The roles of primary care doctors in the COVID-19 pandemic: consistency and influencing factors of doctor's perception and actions and nominal definitions.

BACKGROUND: At the end of 2019, the Coronavirus Disease 2019 (COVID-19) pandemic broke out. As front-line health professionals, primary care doctors play a significant role in screening SARS-CoV-2 infection and transferring suspected cases. However, the performance of primary care doctors is influenced by their knowledge and role perception. A web-based cross-sectional survey was conducted to assess the consistency and influencing factors of primary care doctor's role perception and expert advice in the guidelines (regulatory definition). METHODS: We designed the questionnaire using "Wenjuanxing" platform, distributed and collected the questionnaire through WeChat social platform, and surveyed 1758 primary care doctors from 11 community health service stations, community health service centers and primary hospitals in Zhejiang Province, China. After the questionnaire was collected, descriptive statistics were made on the characteristics of participants, and univariate analysis and multivariate analysis were used to determine the relevant factors affecting their role cognition. RESULTS: In the reporting and referral suspected cases and patients receiving treatment, most participants' cognition of their roles were consistent with the requirements of guidelines. However, 49.54% and 61.43% of participant doctors were not in line with the government guidelines for diagnosing and classifying COVID-19 and treating suspected cases, respectively. Having a middle or senior professional title and participating in front-line COVID-19 prevention and control work is beneficial to the accurate role perception of diagnosis and classification of COVID-19, the reporting and transfer of suspected cases, and the treatment of suspected cases. CONCLUSIONS: Primary care doctors' role perceptions in the COVID-19 pandemic are not always consistent with government guidelines in some aspects, such as transferring and diagnosing suspected cases. Therefore, it is essential to guide primary care doctors in performing their duties, especially those with lower professional titles.

Serum osteocalcin is inversely associated with lower extremity atherosclerotic disease in Chinese patients with type 2 diabetes mellitus.

Serum osteocalcin (OCN) is closely related to metabolic risk factors, and the relationship between OCN and atherosclerosis has been investigated. However, it is still controversial. Herein, we explored the potential correlation between serum total OCN and lower extremity atherosclerotic disease (LEAD) in 326 hospitalized Chinese patients with type 2 diabetes mellitus (T2DM). Femoral intima-media thickness (F-IMT) and lower limb atherosclerotic plaque were assessed through color Doppler ultrasound. Subjects with LEAD had significantly lower serum OCN levels compared with those without LEAD (14.54 [14.10-14.89] ng/mL versus 16.79 [15.86-18.04] ng/mL, p < 0.001). Spearman's correlation analysis revealed that serum OCN levels were positively associated with high density lipoprotein cholesterol (HDL-C) and negatively associated with fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPG), hemoglobin A1c (HbA1c), waist-to-hip ratio (WHR) and F-IMT. Multiple logistic analysis revealed that OCN (OR 0.938, 95% confidence interval (CI 0.933-0.950, p = 0.003) and glomerular filtration rate (GFR) (OR 0.990, 95% CI 0.985-0.996, p = 0.003) were independently and inversely associated with LEAD, while age (OR 1.140, 95% CI 1.127-1.148, p < 0.001), diabetes duration (OR 1.068, 95% CI 1.039-1.080, p < 0.005) and uric acid (UA) (OR 1.005, 95% CI 1.002-1.007, p = 0.032) were independently and positively associated with LEAD. Additionally, multiple linear regression analysis revealed that serum OCN levels were negatively associated with F-IMT (standardized ß = -0.180, p = 0.002). In Chinese patients with T2DM, serum OCN levels were independently and inversely correlated with LEAD.

Changes in inflammatory factors in SV40MES13 mesangial cells after silencing ApoM gene.

OBJECTIVE: Inflammation is an important process in the occurrence and development of nephropathy, and ApoM is closely related to inflammation. This article aims to investigate the inflammatory changes of SV40 MES13 cells after ApoM gene silencing by western blot and to explore the relationship between ApoM and inflammation. METHODS: Control group glomerular mesangial cells (SV40 MES13), and the same cells after adding a small interfering RNA silencing ApoM gene for 24 h were observed under a microscope and photographed. After extracting the protein western blot was used to explore the associated inflammation of IL-6, P-Jak2, Erk, TNF-α, P-JNK, IKKß, P-p38, IκBα, P-IKKα/ß, NF-κB and P-NF-κB expression. RESULTS: Western blot showed that ApoM gene was successfully silenced in SV40 MES13 cells after adding small interfering RNA. The decrease of inflammatory factors IL-6 and P-Jak2 in Jak/Stat pathway was statistically significant. Inflammatory cytokines TNF-α and P-JNK in the NF-κB pathway decreased statistically significantly, while the inflammatory factor IKKß increased statistically significantly. CONCLUSION: Inflammation was suppressed in SV40 cells with ApoM gene silencing.

Sitagliptin downregulates retinol-binding protein 4 and upregulates glucose transporter type 4 expression in a type 2 diabetes mellitus rat model.

The present study was designed to investigate the effects of sitagliptin on metabolic parameters as well as the expression levels of retinol-binding protein 4 (RBP4) and glucose transporter type 4 (GLUT4) in a rat model of type 2 diabetes mellitus. A rat model of type 2 diabetes mellitus was established by a combination of a high-fat diet and intraperitoneal injection of low-dose streptozotocin. Rats were divided into three groups: normal control group, diabetes group, and diabetes + sitagliptin group. Body weight, glycemic parameters, lipid profiles, fasting insulin (FINS) and serum RBP4 levels were assessed at baseline and after 6 weeks of therapy. Western blotting was used to detect the tissue RBP4 and GLUT4 expression levels. After treatment for 6 weeks, the diabetes + sitagliptin group displayed significantly improve levels of blood sugar, blood grease, and insulin sensitizing functions (P < 0.05) than the diabetes group. Sitagliptin markedly down regulated RBP4 expression levels and up-regulated GLUT4 expression levels in adipose tissue and skeletal muscle. The results indicate that sitagliptin can modulate the RBP4-GLUT4 system in adipose tissue and skeletal muscle. Modulation of the RBP4-GLUT4 system may be one of the mechanisms by which sitagliptin ameliorates the symptoms of type 2 diabetes mellitus.