[Further understanding and paying attention to normoalbuminuric diabetic kidney disease].

Diabetes mellitus (DM) has grown up to be an important issue of global public health because of its high incidence rate. Diabetic kidney disease (DKD) is the main cause of end-stage kidney disease (ESKD). Therefore, early diagnosis and timely prevention and treatment of DKD are essential for the progress of DM. The clinical diagnosis and staging of DKD are mostly based on the urinary albumin excretion rate (UAER) and estimated glomerular filtration rate (eGFR). However, clinically, DKD patients show normoalbuminuric diabetic kidney disease (NADKD) instead of clinical proteinuria. The old NADKD concept is no longer suitable and should be updated accordingly with the redefinition of normal proteinuria by NKF/FDA (National Kidney Foundation/Food and Drug Administration). Based on the relevant guidelines of DM and chronic kidney disease (CKD) and combined with the current situation of clinical research, the review described NADKD from the aspects of epidemiology, pathological mechanism, disease diagnosis, clinical characteristics and biomarkers, to arouse the new understanding of NADKD in the medical profession and pay attention to it.

Genetic variability in copper-transporting P-type adenosine triphosphatase (ATP7B) is associated with Alzheimer's disease in a Chinese population.

Previous experiments demonstrated that transgenic mice carrying both amyloid precursor protein and mutant ATP7B transgenes reduce amyloid plaques and diminish plasma Abeta levels. These experiments showed that a structural change of ATP7B may affect Alzheimer’s disease (AD) susceptibility. In this study three missense SNPs in ATP7B gene (rs1801243, rs1801244, and rs1801249) were chosen to test whether they were associated with AD. We tested this hypothesis using a case control design. The experimental data showed that there was a significant deviation from Hardy-Weinberg equilibrium (HWE) for SNP rs1801249 (c.3419 T greater than C, Val1140Ala) in the case group (p = 0.014) but not in the control group and that there was an association between SNP rs1801249 and AD under a recessive model (p = 0.003). The data also showed that the genotype frequency distribution of the ATP7B c.1366 G greater than C polymorphism (rs1801244, Val456Leu) differed significantly between the AD patients and the normal subjects (p = 0.012). In addition, the frequency of the TGC haplotype of SNPs rs1801243, rs1801244, and rs1801249 was significantly higher in the AD patients compared with the normal subjects (p = 8.49×10-7). These observations suggested that genetic variations in the copper transporter gene ATP7B might contribute to AD pathogenesis in the Taiwanese population.

Association analysis of dopaminergic gene variants (Comt, Drd4 And Dat1) with Alzheimer s disease.

Defects in dopaminergic transmission play important roles in the disturbance of synaptic plasticity and even in advanced cognitive behavior. However, the relationship between genes involved in the regulation of dopamine levels and predisposition for Alzheimer s disease (AD) remains unclear. The potential association of dopamine-modulating gene polymorphisms with AD was evaluated. We performed a case-control study with 120 patients and 86 healthy controls. Two catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms (SNPs) (rs2020917 and rs4646312), two dopamine D4 receptor (DRD4) SNPs (rs3758653 and rs916455), and four dopamine transporter (DAT1) SNPs (rs2937639, rs6347, rs12516948 and rs11133762) were investigated. The T allele at the DRD4 SNP (rs3758653) was found to be significantly associated with AD. Our results also showed that haplotype frequencies, observed from the analyzed SNPs, were distributed significantly differently in AD patients vs control subjects. Moreover, a strong association was observed between the A allele at rs6347 of DAT1 and moderate stage of dementia. These observations suggest that genetic variations in the dopamine-modulating genes, COMT, DRD4 and DAT1, may contribute to AD pathogenesis in the Taiwanese population.

The importance of analyzing the serum C3-epimer level for evaluating vitamin D storage in some special populations.

OBJECTIVE: The serum 25-hydroxyvitamin D [25(OH)D] is recommended by various management agencies for evaluating the nutritional status of vitamin D (VitD). However, 25(OH)D cannot reflect the actual composition and activity of VitD in vivo. This study used UPLC-MS/MS to detect the levels of serum VitD metabolites in some special populations, so as to clarify its importance in accurately evaluating VitD storage in vivo. SUBJECTS AND METHODS: A total of 2029 subjects were enrolled, including 1204 cases in minor health (MH), 467 in the minor disease (MD), 119 in the adult health (AH) and 239 in adult disease (AD). Serum VitD2 and VitD3 levels were measured by UPLC-MS/MS. Serum C3-epi concentrations were also measured in 144 subjects by a spot check method. RESULTS: There were significant differences in the levels of VitD2, VitD3 and 25(OH)D among groups (all p <0.001). According to serum level of 25(OH)D, percentage of subjects with sufficient VitD in the MH, MD, AH and AD group were 65.4%, 52.7%, 29.4% and 20.9%, respectively. After converting VitD2 activity to AVitD3, subjects with sufficient VitD in MH, MD, AH and AD group accounted for 53.2%, 40.9%, 17.7% and 11.3%, respectively. C3-epi levels in the MH (z = 7.49, p <0.001), MD (z = 7.03, p <0.001) and AD group (z = 4.68, p <0.001) were higher than that in the AH group. CONCLUSIONS: Not only the serum 25(OH)D level, but also the simultaneous detection of VitD2 and VitD3 levels will overestimate the VitD storage in some subjects. Accurate evaluation of VitD storage in these individuals also requires detection of C3-epi levels.

Comparison of three diagnosis criteria for metabolic syndrome in Mongolian people of agricultural and pastoral regions.

OBJECTIVE: To compare application of the metabolic syndrome (MetS) 3 definitions, proposed by International Diabetes Federation (IDF) in 2005, Adult Treatment Panel III (ATPIII) in 2005 and Chinese Diabetes Society (CDS) in 2004, in Mongolian people of agricultural and pastoral areas in Inner Mongolia, China. METHODS: A cross-sectional survey was conducted in Chaoluto and Guribanhua township of Tongliao City of Inner Mongolia, between June 2003 and August 2004. A total of 2536 Mongolian people aged 20 yr and older completed all the surveys and examinations. Anthropometry, blood pressure, and fasting biochemistry were measured according to standard methods. RESULTS: The age-standardized prevalence of MetS using the IDF, ATPIII, and CDS definitions was 17.1% (men 11.4%, women 21.6%), 22.9% (men 19.6%, women 25.8%) and 8.1% (men 7.6%, women 8.6%), respectively. The agreement of IDF and ATPIII, IDF and CDS, ATPIII and CDS were 93.5%, 85.0%, and 81.6%, and Kappa values were 0.822, 0.434, and 0.419, respectively. Among the subjects who had 3 or more MetS components, 100% were screened by ATPIII criteria, 76.1% by IDF criteria (men 57.3%, women 85.7%), and 33.5% by CDS criteria (men 7.6%, women 8.6%) respectively. CONCLUSIONS: This investigation in Mongolian people showed very high agreement between IDF and ATPIII definitions, and moderate agreement between CDS and 2 other criteria. The cut points of waist circumference for males in IDF and ATPIII seemed high, and whether CDS definition should lower the fasting plasma glucose value from 6.1 to 5.6 mmol/l needs examination through further prospective studies in the Chinese population.

Clinical study on the early application and ideal dosage of urokinase after surgery for hypertensive intracerebral hemorrhage.

OBJECTIVE: The objective of the present study was to investigate the clinical efficacy of early application and ideal dosage of urokinase after minimally invasive surgery for hypertensive intracerebral hemorrhage (HICH). PATIENTS AND METHODS: We consecutively enrolled 132 patients with HICH who underwent CT-guided stereotactic intubation of the hematoma combined with dissolution using urokinase, where the urokinase was injected at 24 h after intubation. The 40 patients in the low-dosage group received 10-30 thousand units of urokinase; the 46 patients in the moderate-dosage group received 40-60 thousand units of urokinase; and the 46 patients in the high-dosage group received 70-100 thousand units of urokinase. After the drainage tubes were clamped for 4-6 h, clamps were removed for drainage for 24 h, and the intubated tubes were maintained for 3-5 d. Patients in all groups were followed up for 6 months, and the clinical outcomes were compared. RESULTS: The clearance of hematomas in the high-dosage group was significantly improved compared with the other two groups (p<0.05), and the occurrence rates of complications in the moderate- and high-dosage groups were significantly higher than in the low-dosage group (p<0.05). During follow-up, the Chinese stroke scale and Barthel index scores in the high-dosage group were higher than those in the other two groups (p<0.05). The serum levels of matrix metalloproteinase-9 (MMP-9) and neuron-specific enolase (NSE) in the high-dosage group were lower than those in the other two groups (p<0.05). CONCLUSIONS: CT-guided stereotactic intubation of the hematoma combined with dissolution using urokinase is effective for eliminating the hematoma for treatment of HICH with few complications. For recovery of neurological functions and improvement of regular life skills, it is considered to be associated with decreases in the serum levels of MMP-9 and NSE.

Intrapartum amnioinfusion for replacement of meconium-stained-amniotic-fluid to prevent meconium aspiration syndrome.

The presence of meconium-stained amniotic-fluid (MSAF) during labor in cephalic presentation is a potentially ominous sign of fetal distress and, a direct cause of meconium aspiration syndrome (MAS). The authors designed a new method of intrapartum amnioinfusion for replacement (IAR) of the MSAF with normal saline solution. A total of 177 parturients with MSAF were studied from July 1986 to January 1987. Seventy-three cases receiving IAR treatment were analysed and 104 cases treated routinely served as controls. The newborn infants receiving IAR treatment had a significantly lower incidence of neonatal asphyxia (P less than 0.001) and MAS (P less than 0.05). No neonatal death occurred in the treated group; whereas, three infants died in the controls. There was no significant difference in puerperal morbidity between these two groups. The results of this study suggest that IAR might be a hopeful and effective treatment for parturients with MSAF in reducing the incidence of MAS.

[Use of fetal heart rate scoring system in intrapartum fetal monitoring].

A scoring system of intermittent 5-second successive fetal heart rate auscultation was devised for intrapartum fetal monitoring. Its use among 150 cases in two hospitals, yielded a negative predictive rate of 93.8% and a positive rate of 71.4%, higher than that of the routine auscultation method. The scoring system was also well correlated with the umbilical blood gases values. Hence, it is recommended for intrapartum fetal monitoring, especially, where electronic monitoring is not available.

[Estrogen and progesterone levels in serum and amniotic fluid before or during term labor and their relationship to uterine activity].

Estradiol (E2), estriol (E3) and progesterone (P) were measured in the serum and amniotic fluid by radioimmunoassay in 73 cases, both before or during term labor. The results showed: (1) the serum E2, E3, P, E2/P and Es/P values did not differ significantly between the two groups; (2) the amniotic fluid E2 and E3 concentrations were significantly higher for women in active labor and more evident in those with normal uterine activity, but the progesterone concentration did not vary significantly among the three groups. Thus, the increase of estrogen and estrogen/progesterone ratio in amniotic fluid may be related to the mechanism of spontaneous onset of term parturition in human and as well to dysfunctional labor.

[Intrapartum amnio-infusion in patients with oligohydramnios].

Patients with oligohydramnios are at increased risk of developing fetal distress during labor, presumably as the result of umbilical cord compression. Intrapartum saline amnio-infusion for short-term amnionic fluid replacement was performed in a prospective randomized manner in 60 cases of oligohydramnios during period of 1-year. Patients receiving amnio-infusion had significantly lower incidence of neonatal asphyxia and less cesarean sections as compared with the controls. No neonatal nor maternal complication occurred. The effect of amnio-infusion was also confirmed by B type ultrasonic examination. These results suggested that intrapartum saline amnio-infusion might be a hopeful therapy for patients with oligohydramnios.