High-normal urinary albumin-to-creatinine ratio is independently associated with metabolic syndrome in Chinese patients with type 2 diabetes mellitus: A cross-sectional community-based study.

AIMS/INTRODUCTION: Microalbuminuria is positively related to metabolic syndrome (MetS). Our aim was to investigate whether urinary albumin-to-creatinine ratio (UACR) within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes. MATERIALS AND METHODS: A total of 514 participants (206 males and 308 females; mean age 66 years) with UACR less than 3.5 mg/mmol were enrolled from two downtown areas of Shanghai. The participants were stratified into quartiles according to UACR levels. The prevalence of MetS was assessed and compared among the four groups by binary logistic regression. RESULTS: Compared with participants with UACRs in the first quartile, the other quartiles had a higher prevalence of MetS (65.9%, 74.4% and 81.3%, respectively, P = 0.001) after adjustment for sex and age. After adjusting for potential confounders, participants in the second to the fourth quartile group had a 1.36-, 1.84- and 2.73-fold risk of MetS, respectively, relative to those in the lowest quartile. Furthermore, UACR, whether as quartile groups or as a continuous variable, is an independent predictor of MetS after fully adjusting for other variables. CONCLUSIONS: These results suggest that UACR even within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes mellitus.

Serum uric acid levels are associated with hypertension and metabolic syndrome but not atherosclerosis in Chinese inpatients with type 2 diabetes.

OBJECTIVE: Serum uric acid (SUA) is associated with many cardiovascular risk factors such as hypertension (HTN) and metabolic syndrome (MetS). However, the association of SUA with atherosclerosis remains controversial. Our aim was to investigate the relationships of SUA with HTN, MetS and atherosclerosis in Chinese inpatients with type 2 diabetes. METHODS: This cross-sectional study was performed with a sample of 2388 hospitalized Chinese patients with type 2 diabetes. Both carotid and lower limb atherosclerotic lesions were assessed for intima-media thickness, plaque and stenosis by Doppler ultrasound. Atherosclerotic plaque and stenosis were defined as the presence of either carotid or lower limb plaques and stenoses, respectively. RESULTS: There were significant increases in the prevalence of both HTN and MetS across the SUA quartiles (HTN: 43.4, 49.6, 56.1 and 66.3% for the first, second, third and fourth quartiles, respectively, P < 0.001; MetS: 59.9, 68.8, 74.7 and 84.9% for the first, second, third and fourth quartiles, respectively, P < 0.001). A fully adjusted multiple logistic regression analysis revealed that SUA quartile was independently associated with the presence of HTN (P = 0.001) and MetS (P = 0.006). The prevalence of atherosclerotic plaque and stenosis was obviously higher in the patients with either HTN or MetS than in those without HTN or MetS. However, there was no significant association of SUA quartile with the presence of atherosclerotic lesions. CONCLUSIONS: SUA levels were closely associated with HTN and MetS, but not with atherosclerosis in type 2 diabetes. Our findings strongly suggest that, in select populations such as those with type 2 diabetes, the role of uric acid in atherosclerosis might be attributable to other cardiovascular risk factors, such as HTN and MetS.

Low-grade albuminuria is associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes.

BACKGROUND: Low-grade albuminuria is associated with cardiovascular risk factors and mortality. Our aim was to investigate the association between low-grade albuminuria and carotid atherosclerotic lesions in community-based patients with type 2 diabetes. METHODS: A cross-sectional study was performed in 475 community-based patients with type 2 diabetes (190 males and 285 females) with normal urinary albumin-to-creatinine ratios (UACR) (< 3.5 mg/mmol) from Shanghai, China. The subjects were stratified into tertiles based on UACR levels (the lowest tertile was UACR ≤ 1.19 mg/mmol, and the highest tertile was UACR ≥ 2 mg/mmol). Carotid intima-media thickness (CIMT), carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on ultrasonography. The urinary albumin excretion rate was determined as the mean of the values obtained from three separate early morning urine samples. RESULTS: Compared with the subjects with UACR in the lowest tertile, the subjects with UACR in the middle and highest tertiles had greater CIMT values (0.88 ± 0.35 mm, 0.99 ± 0.43 mm and 1.04 ± 0.35 mm, respectively; all p < 0.05) and a higher prevalence of carotid atherosclerotic plaques (25.3%, 39.0% and 46.2%, respectively; all p < 0.05) after adjusting for sex and age. Fully adjusted multiple linear regression and logistic regression analyses revealed that UACR tertiles were significantly associated with elevated CIMT (p = 0.007) and that, compared with the subjects in the first tertile of UACR, those in the second and third tertiles had 1.878- and 2.028-fold risk of carotid plaques, respectively. However, there was no statistical association between UACR tertile and the prevalence of carotid stenosis. CONCLUSIONS: Higher UACR within the normal range was independently associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes. Low-grade albuminuria contributes to the risk of carotid atherosclerosis and may be used as an early marker for the detection of atherosclerosis in patients with type 2 diabetes.

Distal protection devices in primary percutaneous coronary intervention of native coronary artery lesions: a meta-analysis of randomized controlled trials.

OBJECTIVE: The use of embolic protection devices to decrease major adverse cardiac events (MACEs) in patients with saphenous vein graft lesions is considered class I therapy by the recent practice guidelines. However, the benefits of adjunctive protection devices to prevent distal embolization in patients with native coronary artery lesions are still a matter of debate. Therefore, we performed the meta-analysis to determine whether the use of distal protection devices during revascularization can improve myocardial perfusion and reduce the occurrence of MACEs compared with primary percutaneous coronary intervention (PCI) alone. METHODS AND RESULTS: Studies were identified in English-language articles by search of Medline and Embase database (inception to December 2011). A total of 15 prospective randomized controlled trials involving 2783 patients were included for analysis (1378 patients in the distal protection device group and 1405 cases in the control group). Overall, adjunctive embolic protection was associated with significantly improved postprocedural TIMI 3 (thrombolysis in myocardial infarction 3) flow (OR 1.71; 95% CI 1.13-2.57; P = 0.01) and MBG 3 (myocardial blush grade 3) (OR 1.50; 95% CI 1.09-2.07; P = 0.01), whereas the overall MACEs analysis demonstrated that a nonsignificant trend was observed toward better clinical outcomes associated with adjunctive protection devices at 1 month (OR 0.80; 95% CI 0.55-1.15; P = 0.23) and at 6 months (OR 0.80; 95% CI 0.55-1.17; P = 0.24). When stratified by MACEs, no statistical differences were found among mortality, reinfarction, and target vessel revascularization (TVR), respectively. CONCLUSIONS: The meta-analysis indicated an improvement of myocardial perfusion in AMI patients treated with adjunctive protection devices. However, a nonsignificant trend was observed toward a lower risk of MACEs in the distal protection device group when compared with the control group.

[Clinical features and risk factors of renal damage in elderly and non-elderly patients with type 2 diabetes mellitus].

OBJECTIVE: To investigate the clinical features and risk factors of renal damage in the elderly and non-elderly patients with type 2 diabetes mellitus. METHODS: The data were collected from a survey of 10-year retrospective study of chronic complications of hospitalized type 2 diabetics organized by Chinese Diabetes Society. A total of 1351 patients of type 2 diabetes were selected and divided into an elderly group (>or=60 year) and a non-elderly group (<60 year). The patients were also divided into three groups according to urinary albumin excretion rate (AER): normoalbuminuria group (AER<30 mg/24 h), microalbuminuria group (30or=300 mg/24 h). eGFR was estimated by the equation from the MDRD study. Clinical and laboratory parameters of all patients were analyzed. RESULTS: (1) The proportions of renal insufficiency in both normoalbuminuria and microalbuminuria groups of type 2 diabetes in the elderly patients were significantly higher than those in the non-elderly patients (26.7% vs 15.8%, P<0.01; 30.5% vs 21.3%, P<0.05 respectively); (2) in type 2 diabetic patients with renal insufficiency and normoalbuminuria, the diabetes duration (7.7 vs 3.8 years), systolic blood pressure [(146+/-24) mm Hg vs (134+/-23) mm Hg], diastolic blood pressure [(84+/-13) mm Hg vs (80+/-11) mm Hg], proportion of hypertension (37.8% vs 21.1%), diabetic retinopathy (34.1% vs 23.9%), cardiovascular diseases (31.6% vs 11.3%) and cerebrovascular disease (24.4% vs 9.9%) were significantly higher in the elderly group than in the non-elderly group (P<0.05 or 0.01); (3) multiple logistic regression analysis revealed that the duration of diabetes (OR=1.046, P=0.013) and systolic blood pressure (OR=1.014, P=0.002) were independently associated with renal insufficiency in the elderly type 2 diabetic patients with normoalbuminuria, whereas systolic blood pressure (OR=1.042, P=0.000) and 2-hour postprandial blood glucose (OR=1.048, P=0.002) were independent risk factors for renal insufficiency of non-elderly patients. CONCLUSION: The elderly type 2 diabetic patients are likely to suffer renal insufficiency initially from a lower glomerular filtration rate than the non-elderly patients. Systolic blood pressure is the main risk factor in both elderly and non-elderly type 2 diabetes with normoalbuminuria and a decreased renal function. Controlling blood pressure may delay the decline of renal function.

[Expression of mucin-l and beta-catenin in papillary thyroid carcinoma and the clinical significance thereof].

OBJECTIVE: To investigate the expression levels of mucin-1 (MUC1) and beta-catenin in papillary thyroid carcinoma, the significance thereof in the carcinogenesis and development of tumor. METHODS: Specimens of thyroid tissues were collected from 53 patients of papillary thyroid carcinoma, and 20 patients of nodular goiter, including 20 specimens of the tissues with thyroid nodules and 20 specimens of normal thyroid tissues adjacent to the nodules (as controls). Immunohistochemistry was used to detect the expression of MUC1 and beta-catenin in these tissues. The correlation of the expression of MUC1/beta-catenin with different clinico-pathological parameters of the papillary thyroid carcinoma patients was analyzed. RESULTS: The MUC1 expression level of the tissues of the papillary thyroid carcinoma tissue was (134 +/- 10, gray scale), significantly higher than those of nodular goiter group (101 +/- 7, gray scale) and the control group (99 +/- 6, gray scale) (both P < 0.01). The positive expression rate of MUC1 in the tissues of papillary thyroid carcinoma was 56.6%, significantly higher than those in the nodular goiter and control groups (15.0% and 5.0% respectively, both P < 0.01). The positive beta-catenin expression rate of the papillary thyroid carcinoma group was 71.7%, significantly higher than those of the nodular goiter and control groups (40.0% and 20.0% respectively, both P < 0.05). The positive MUC1 expression rate of the papillary thyroid carcinoma patients with lymph node metastasis was 68.4% (26/38), significantly higher than that of the patients without lymph node metastasis (26.7%, 4/15, P < 0.05), however, there were no significant differences in the MUC1 expression rate among the papillary thyroid carcinoma patients different in sex, age, and tumor size (all P > 0.05). The beta-catenin expression rates of the papillary thyroid carcinoma patients different in sex, age, tumor size, and lymph node metastasis status were not significantly different (all P > 0.05). Binary Logistic regression analysis showed that abnormal expression of MUC1 and beta-catenin were positively correlated with the pathogenesis of papillary thyroid carcinoma (all P < 0.05), and lymph node metastasis status and abnormal expression of beta-catenin were positively correlated with MUC1 expression (P < 0.05). CONCLUSION: Playing an important role in the carcinogenesis and development of papillary thyroid carcinoma, MUC1 can be used as a biomarker in this carcinoma. There was a significant positive correlation between MUC1 expression and beta-catenin expression.

[Molecular cloning of a novel gene, C5orf21 gene and its roles in diabetic macroangiopathy].

OBJECTIVE: To clone a novel diabetic angiopathy related protein gene-C5orf21 and study its roles in diabetic macroangiopathy. METHODS: The open reading frame (ORF) of C5orf21 gene was cloned into vector from human aortic tissues by a RT-PCR-based approach and identified by enzyme-cutting and sequencing. The structure and function of C5orf21 gene and protein were further analyzed by bioinformatics technology. The mRNA expression of C5orf21 gene in human tissues and in vascular cells was analyzed by RT-PCR. RT-PCR was used to observe the effect of high glucose, low-density lipoprotein (LDL) and free fatty acid (FFA) upon the expression of C5orf21 gene in macrophages. RESULTS: C5orf21 gene was successfully inserted into pDrive vector and identified for the first time at the level of mRNA. There are five C5orf21 gene splice variants in human aortic tissue and their length of ORF are 1251, 1113, 894, 810 and 810 bp respectively. Two kinds of splice variants have yet to be included in GenBank database. Two kinds of splice variants have the same ORF and their differences are mainly in the bases in the 5' untranslated region. Bioinformatics analysis found that C5orf21 gene was located in chromosome 5q15 and C5orf21 protein contained Arb2 domain associated with histone H3 lysine 9 methylation. C5orf21 gene was normally expressed in many tissues. Fat and aortic tissues had the highest expression. The expression of C5orf21 gene could be detected in human aortic endothelial cell, aortic smooth muscle cell and macrophages. High glucose, LDL and FFA (esp.high glucose) up-regulated the expression of C5orf21 gene in macrophage. CONCLUSION: C5orf21 gene contains five splice variants and it is identified for the first time at the level of mRNA. The changes of C5orf21 gene expression are correlated with diabetic macroangiopathy.

[An epidemiological study on diabetic retinopathy among type 2 diabetic patients in Shanghai].

OBJECTIVE: To investigate the prevalence and risk factors of diabetic retinopathy (DR) among type 2 diabetic patients aged over 30 in Shanghai central area. METHODS: 1039 patients diagnosed with type 2 diabetes mellitus (DM) aged over 30 were investigated by randomized cluster sampling in Shanghai central area and data from 767 of those patients were analyzed. RESULTS: (1) Among all of the 1534 digital ocular fundus images from 767 patients, 87.6% of the images from 672 patients were gradable. (2) Among all of the 672 patients with gradable ocular fundus images, the prevalence of non-proliferative diabetic retinopathy (NPDR) was 21.6%, while proliferative diabetic retinopathy (PDR) was 1.3%. The rates of mild, moderate and severe NPDR were 8.8%, 11.2% and 1.6% respectively. (3) DR patients were characterized with elder age, higher HbA1c, urea nitrogen and serum creatinine. DM duration and the level of fasting plasma glucose were risk factors for DR. CONCLUSION: The overall prevalence of DR in type 2 diabetic patients aged over 30 in Shanghai central area was 22.9% and the DR risk factors were found to include duration of diabetes and fasting plasma glucose level.