BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(C...BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.展开更多
BACKGROUND Cardiovascular disease(CVD)is the leading cause of death globally,and diabetes mellitus(DM)is a well-established risk factor.Among the risk factors for CVD,DM is a major modifiable factor.In the fatal CVD o...BACKGROUND Cardiovascular disease(CVD)is the leading cause of death globally,and diabetes mellitus(DM)is a well-established risk factor.Among the risk factors for CVD,DM is a major modifiable factor.In the fatal CVD outcomes,acute myocardial infarction(AMI)is the most common cause of death.AIM To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM on the basis of the hypothesis that good quality of care can reduce the risk of AMI in patients with DM.METHODS Using Taiwan’s Longitudinal Cohort of Diabetes Patients Database and the medical charts of a medical center,we identified incident patients diagnosed with type 2 DM from 1999 to 2003 and followed them until 2011.We constructed a summary quality-of-care score(with values ranging from 0 to 8)with process indicators(frequencies of HbA1c and lipid profile testing and urine,foot and retinal examinations),intermediate outcome indicators(low-density lipoprotein,blood pressure and HbA1c),and co-morbidity of hypertension.The associations between the score and the incidence of AMI were evaluated using Cox regression models.RESULTS A total of 7351 patients who had sufficient information to calculate the score were enrolled.In comparison with participants who had scores≤1,those with scores between 2 and 4 had a lower risk of developing AMI[adjusted hazard ratio(AHR)=0.71;95% confidence interval(95%CI):0.55-0.90],and those with scores≥5 had an even lower risk(AHR=0.37;95%CI:0.21-0.66).CONCLUSION Good quality of care can reduce the risk of AMI in patients with type 2 DM.The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.展开更多
Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enoug...Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.展开更多
BACKGROUND Wilson’s disease(WD)is a rare autosomal recessive inherited disorder of copper metabolism.Acute liver failure(ALF)and hemolytic anemia represent the most severe presentation of WD in children.No clear geno...BACKGROUND Wilson’s disease(WD)is a rare autosomal recessive inherited disorder of copper metabolism.Acute liver failure(ALF)and hemolytic anemia represent the most severe presentation of WD in children.No clear genotype-phenotype correlations exist in WD.Protein-truncating nonsense,frame-shift,or splice-site variants may be associated with more severe disease.In contrast,missense variants may be associated with late-onset,less severe disease,and more neurological manifestations.Recently,a gene variant(HSD17B13:TA,rs72613567)with a possible hepatic protective role against toxins was associated with a less severe hepatic phenotype in WD.AIM To analyze the possible genotype-phenotype correlations in children with WD presented with ALF and non-immune hemolytic anemia.METHODS The medical records of children with WD diagnosed and treated in our hospital from January 2006 to December 2020 were retrospectively analyzed.The clinical manifestations(ALF with non-immune hemolytic anemia or other less severe forms),laboratory parameters,copper metabolism,ATP7B variants,and the HSD17B13:TA(rs72613567)variant were reviewed to analyze the possible genotype-phenotype correlations.RESULTS We analyzed the data of 51 patients with WD,26 females(50.98%),with the mean age at the diagnosis of 12.36±3.74 years.ALF and Coombs-negative hemolytic anemia was present in 8 children(15.67%),all adolescent girls.The Kayser-Fleisher ring was present in 9 children(17.65%).The most frequent variants of the ATP7B gene were p.His1069Gln(c.3207A>G)in 38.24% of all alleles,p.Gly1341Asp(c.4021G>A)in 26.47%,p.Trp939Cys(c.2817G>T)in 9.80%,and p.Lys844Ter(c.2530A>T)in 4.90%.In ALF with hemolytic anemia,p.Trp939Cys(c.2817G>T)and p.Lys844Ter(c.2530A>T)variants were more frequent than in other less severe forms,in which p.His1069Gln(c.3207A>G)was more frequent.p.Gly1341Asp(c.4021G>A)has a similar frequency in all hepatic forms.For 33 of the patients,the HSD17B13 genotype was evaluated.The overall HSD17B13:TA allele frequency was 24.24%.Its frequency was higher in patients with less severe liver disease(26.92%)than those with ALF and hemolytic anemia(14.28%).CONCLUSION It remains challenging to prove a genotype-phenotype correlation in WD patients.In children with ALF and hemolytic anemia,the missense variants other than p.His1069Gln(c.3207A>G)and frame-shift variants were the most frequently present in homozygous status or compound heterozygous status with site splice variants.As genetic analysis is usually time-consuming and the results are late,the importance at the onset of the ALF is questionable.If variants proved to be associated with severe forms are found in the pre-symptomatic phase of the disease,this could be essential to predict a possible severe evolution.展开更多
Type 2 diabetes mellitus(T2DM)is a common clinical endocrine and metabolic disease characterized by elevated blood sugar and insulin resistance.The onset of T2DM will affect the metabolic balance of the body,and uric ...Type 2 diabetes mellitus(T2DM)is a common clinical endocrine and metabolic disease characterized by elevated blood sugar and insulin resistance.The onset of T2DM will affect the metabolic balance of the body,and uric acid metabolism is one of them.Hyperuricemia(HUA)is very common in type 2 diabetes.Based on HUA,gout is a crystal-related disease caused by urate deposition,and its clinical manifestations are complex and varied.Professor zhao quanlin has rich experience in clinical experience,and he has made good use of traditional Chinese medicine system to treat type 2 diabetes mellitus with gout in the acute phase of clinical effect.展开更多
In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart...In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart failure,atrial fibrillation,primary prevention of atherosclerotic cardiovascular disease/cardiovascular disease,and acute myocardial infarction.We searched the data of randomized controlled trials and meta-analyses of SGLTis in patients with diabetes from PubMed between January 1,2020 and April 6,2024 for our review.According to our review,certain SGLTis(empagliflozin,dapagliflozin,canagliflozin,and tofogliflozin),but not sodium-glucose cotransporter 1 inhibitor(SGLT1i),exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases.Proper utilization of SGLTis in these patients can foster clinical improvement and offer an alternative medication option.However,clinical trials involving SGLTis for certain diseases have relatively small sample sizes,brief intervention durations,and conclusions based on weak evidence,necessitating additional data.These findings are significant and valuable for providing a more comprehensive reference and new possibilities for the clinical utilization and scientific exploration of SGLTis.展开更多
This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease(CVD),focusing particularly on type-2 diabetes mellitus(T...This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease(CVD),focusing particularly on type-2 diabetes mellitus(T2DM)and acute coronary syndrome(ACS).The central piece of this synthesis is a study that investigates the balance between oxidative stress and antioxidant systems in the body through the analysis of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)levels in T2DM patients with ACS.This study highlights serum bilirubin as a protective antioxidant factor,while elevatedγ-GGT levels indicate increased oxidative stress and correlate with major adverse cardiovascular events.Complementary to this,other research contributions revealγ-GGT’s role as a risk factor in ACS,its association with cardiovascular mortality in broader populations,and its link to metabolic syndrome,further elucidating the metabolic dysregulation in CVDs.The collective findings from these studies underscore the critical roles ofγ-GGT and serum bilirubin in cardiovascular health,especially in the context of T2DM and ACS.By providing a balanced view of the body’s oxidative and antioxidative mechanisms,these insights suggest potential pathways for targeted interventions and improved prognostic assessments in patients with T2DM and ACS.This synthesis not only corroborates the pivotal role ofγ-GGT in cardiovascular pathology but also introduces the protective potential of antioxidants like bilirubin,illuminating the complex interplay between T2DM and heart disease.These studies collectively underscore the critical roles of serum bilirubin andγ-GGT as biomarkers in cardiovascular health,particularly in T2DM and ACS contexts,offering insights into the body’s oxidative and antioxidative mechanisms.This synthesis of research supports the potential of these biomarkers in guiding therapeutic strategies and improving prognostic assessments for patients with T2DM and some CVD.展开更多
Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk element...Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.展开更多
In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is l...In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is little knowledge concerning the pervasiveness of uncommon presentations in diabetics. The symptomatology of acute coronary syndrome, which comprises both pain and non-pain symptoms, may be affected by traditional risk factors such as age, gender, smoking, hypertension, diabetes, and dyslipidemia. Such atypical symptoms may range from silent myocardial ischemia to a wide spectrum of non-chest pain symptoms. Worldwide, few studies have highlighted this under-investigated subject, and this aspect of ischemic heart disease has also been under-evaluated in the major clinical trials. The results of these studies are highly diverse which makes definitive conclusions regarding the spectrum of atypical presentation of acute and even stable chronic coronay artery disease difficult to confirm. This may have a significant impact on the morbidity and mortality of coronary artery disease in diabetics. In this up-to-date review we will try to analyze the most recent studies on the atypical presentations in both acute and chronic ischemic heart disease which may give some emphasis to this under-investigated topic.展开更多
Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities...Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.展开更多
Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2 has become a worldwide public health crisis.Studies have demonstrated that diabetes and dyslipidaemia are common comorbiditie...Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2 has become a worldwide public health crisis.Studies have demonstrated that diabetes and dyslipidaemia are common comorbidities and could be high-risk factors for severe COVID-19.Vitamin D,a group of fatsoluble compounds responsible for intestinal absorption of calcium,magnesium,and phosphate,has been widely used as a dietary supplement for the prevention and treatment of numerous diseases,including infectious and non-infectious diseases,due to its high cost-effectiveness;safety;tolerability;and anti-thrombotic,anti-inflammatory,antiviral,and immunomodulatory properties.In this letter to the editor,we mainly discuss the potential role of vitamin D in patients with diabetes,dyslipidaemia,and COVID-19.展开更多
Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glom...Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate （eGFR） and ejection fraction （AGEF） score （age/EF（％）＋1 （if eGFR was ＜60 ml·min-1·1.73 m2）） as an predictor of CIAKI in patients with diabetes mellitus （DM） and concomitant chronic kidney disease （CKD）.Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl （44.2 mmol/L） or 25％ above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic （ROC） analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows：AGEFlow ≤0.92 （n=1 006）; 0.92 ＜AGEFmid ≤1.16 （n=1 000）,and ACEFhigh ＞1.16 （n=992）.The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores （AGEFlow=1.1％,AGEFmid=2.3％ and AGEFhigh=5.8％,P ＜0.001）.By multivariate analysis,AGEF score was an independent predictor of CIAKI （odds ratio=4.96,95％ CI：2.32-10.58,P ＜0.01）.ROC analysis showed that the area under the curve was 0.70 （95％ CI：0.648-0.753,P ＜0.001）.Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.展开更多
Two years after the coronavirus disease 2019(COVID-19)pandemic,acute hepatitis of unknown etiology in children(AHUCD)began to be reported worldwide.The novel coronavirus and adenovirus were found in pathogen and antib...Two years after the coronavirus disease 2019(COVID-19)pandemic,acute hepatitis of unknown etiology in children(AHUCD)began to be reported worldwide.The novel coronavirus and adenovirus were found in pathogen and antibody tests in AHUCD cases reported by the World Health Organization.Children are not exposed to the viruses that children are generally exposed to owing to COVID-19 infection preventive measures such as isolation and wearing masks;therefore,some researchers have speculated that this disease is related to reduced exposure to pathogens.Some scientists have also speculated that the disease is related to liver injury and adenoviral hepatitis,which are the sequelae of COVID-19.Some evidence also suggests a weak association between the disease and COVID-19 vaccination.Therefore,further research and investigation of the pathogenesis,preventive measures,and early treatment of hepatitis of unknown etiology are required.This study aimed to synthesize available evidence to further elucidate this disease in order to treat and prevent it effectively.展开更多
文摘BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.
基金Supported by the Chi-Mei Medical Center,No.CMNCKU10214 and No.CMFHR112027.
文摘BACKGROUND Cardiovascular disease(CVD)is the leading cause of death globally,and diabetes mellitus(DM)is a well-established risk factor.Among the risk factors for CVD,DM is a major modifiable factor.In the fatal CVD outcomes,acute myocardial infarction(AMI)is the most common cause of death.AIM To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM on the basis of the hypothesis that good quality of care can reduce the risk of AMI in patients with DM.METHODS Using Taiwan’s Longitudinal Cohort of Diabetes Patients Database and the medical charts of a medical center,we identified incident patients diagnosed with type 2 DM from 1999 to 2003 and followed them until 2011.We constructed a summary quality-of-care score(with values ranging from 0 to 8)with process indicators(frequencies of HbA1c and lipid profile testing and urine,foot and retinal examinations),intermediate outcome indicators(low-density lipoprotein,blood pressure and HbA1c),and co-morbidity of hypertension.The associations between the score and the incidence of AMI were evaluated using Cox regression models.RESULTS A total of 7351 patients who had sufficient information to calculate the score were enrolled.In comparison with participants who had scores≤1,those with scores between 2 and 4 had a lower risk of developing AMI[adjusted hazard ratio(AHR)=0.71;95% confidence interval(95%CI):0.55-0.90],and those with scores≥5 had an even lower risk(AHR=0.37;95%CI:0.21-0.66).CONCLUSION Good quality of care can reduce the risk of AMI in patients with type 2 DM.The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.
文摘Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.
文摘BACKGROUND Wilson’s disease(WD)is a rare autosomal recessive inherited disorder of copper metabolism.Acute liver failure(ALF)and hemolytic anemia represent the most severe presentation of WD in children.No clear genotype-phenotype correlations exist in WD.Protein-truncating nonsense,frame-shift,or splice-site variants may be associated with more severe disease.In contrast,missense variants may be associated with late-onset,less severe disease,and more neurological manifestations.Recently,a gene variant(HSD17B13:TA,rs72613567)with a possible hepatic protective role against toxins was associated with a less severe hepatic phenotype in WD.AIM To analyze the possible genotype-phenotype correlations in children with WD presented with ALF and non-immune hemolytic anemia.METHODS The medical records of children with WD diagnosed and treated in our hospital from January 2006 to December 2020 were retrospectively analyzed.The clinical manifestations(ALF with non-immune hemolytic anemia or other less severe forms),laboratory parameters,copper metabolism,ATP7B variants,and the HSD17B13:TA(rs72613567)variant were reviewed to analyze the possible genotype-phenotype correlations.RESULTS We analyzed the data of 51 patients with WD,26 females(50.98%),with the mean age at the diagnosis of 12.36±3.74 years.ALF and Coombs-negative hemolytic anemia was present in 8 children(15.67%),all adolescent girls.The Kayser-Fleisher ring was present in 9 children(17.65%).The most frequent variants of the ATP7B gene were p.His1069Gln(c.3207A>G)in 38.24% of all alleles,p.Gly1341Asp(c.4021G>A)in 26.47%,p.Trp939Cys(c.2817G>T)in 9.80%,and p.Lys844Ter(c.2530A>T)in 4.90%.In ALF with hemolytic anemia,p.Trp939Cys(c.2817G>T)and p.Lys844Ter(c.2530A>T)variants were more frequent than in other less severe forms,in which p.His1069Gln(c.3207A>G)was more frequent.p.Gly1341Asp(c.4021G>A)has a similar frequency in all hepatic forms.For 33 of the patients,the HSD17B13 genotype was evaluated.The overall HSD17B13:TA allele frequency was 24.24%.Its frequency was higher in patients with less severe liver disease(26.92%)than those with ALF and hemolytic anemia(14.28%).CONCLUSION It remains challenging to prove a genotype-phenotype correlation in WD patients.In children with ALF and hemolytic anemia,the missense variants other than p.His1069Gln(c.3207A>G)and frame-shift variants were the most frequently present in homozygous status or compound heterozygous status with site splice variants.As genetic analysis is usually time-consuming and the results are late,the importance at the onset of the ALF is questionable.If variants proved to be associated with severe forms are found in the pre-symptomatic phase of the disease,this could be essential to predict a possible severe evolution.
基金National natural science foundation of China(No.81774254)。
文摘Type 2 diabetes mellitus(T2DM)is a common clinical endocrine and metabolic disease characterized by elevated blood sugar and insulin resistance.The onset of T2DM will affect the metabolic balance of the body,and uric acid metabolism is one of them.Hyperuricemia(HUA)is very common in type 2 diabetes.Based on HUA,gout is a crystal-related disease caused by urate deposition,and its clinical manifestations are complex and varied.Professor zhao quanlin has rich experience in clinical experience,and he has made good use of traditional Chinese medicine system to treat type 2 diabetes mellitus with gout in the acute phase of clinical effect.
文摘In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart failure,atrial fibrillation,primary prevention of atherosclerotic cardiovascular disease/cardiovascular disease,and acute myocardial infarction.We searched the data of randomized controlled trials and meta-analyses of SGLTis in patients with diabetes from PubMed between January 1,2020 and April 6,2024 for our review.According to our review,certain SGLTis(empagliflozin,dapagliflozin,canagliflozin,and tofogliflozin),but not sodium-glucose cotransporter 1 inhibitor(SGLT1i),exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases.Proper utilization of SGLTis in these patients can foster clinical improvement and offer an alternative medication option.However,clinical trials involving SGLTis for certain diseases have relatively small sample sizes,brief intervention durations,and conclusions based on weak evidence,necessitating additional data.These findings are significant and valuable for providing a more comprehensive reference and new possibilities for the clinical utilization and scientific exploration of SGLTis.
文摘This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease(CVD),focusing particularly on type-2 diabetes mellitus(T2DM)and acute coronary syndrome(ACS).The central piece of this synthesis is a study that investigates the balance between oxidative stress and antioxidant systems in the body through the analysis of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)levels in T2DM patients with ACS.This study highlights serum bilirubin as a protective antioxidant factor,while elevatedγ-GGT levels indicate increased oxidative stress and correlate with major adverse cardiovascular events.Complementary to this,other research contributions revealγ-GGT’s role as a risk factor in ACS,its association with cardiovascular mortality in broader populations,and its link to metabolic syndrome,further elucidating the metabolic dysregulation in CVDs.The collective findings from these studies underscore the critical roles ofγ-GGT and serum bilirubin in cardiovascular health,especially in the context of T2DM and ACS.By providing a balanced view of the body’s oxidative and antioxidative mechanisms,these insights suggest potential pathways for targeted interventions and improved prognostic assessments in patients with T2DM and ACS.This synthesis not only corroborates the pivotal role ofγ-GGT in cardiovascular pathology but also introduces the protective potential of antioxidants like bilirubin,illuminating the complex interplay between T2DM and heart disease.These studies collectively underscore the critical roles of serum bilirubin andγ-GGT as biomarkers in cardiovascular health,particularly in T2DM and ACS contexts,offering insights into the body’s oxidative and antioxidative mechanisms.This synthesis of research supports the potential of these biomarkers in guiding therapeutic strategies and improving prognostic assessments for patients with T2DM and some CVD.
文摘Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.
文摘In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is little knowledge concerning the pervasiveness of uncommon presentations in diabetics. The symptomatology of acute coronary syndrome, which comprises both pain and non-pain symptoms, may be affected by traditional risk factors such as age, gender, smoking, hypertension, diabetes, and dyslipidemia. Such atypical symptoms may range from silent myocardial ischemia to a wide spectrum of non-chest pain symptoms. Worldwide, few studies have highlighted this under-investigated subject, and this aspect of ischemic heart disease has also been under-evaluated in the major clinical trials. The results of these studies are highly diverse which makes definitive conclusions regarding the spectrum of atypical presentation of acute and even stable chronic coronay artery disease difficult to confirm. This may have a significant impact on the morbidity and mortality of coronary artery disease in diabetics. In this up-to-date review we will try to analyze the most recent studies on the atypical presentations in both acute and chronic ischemic heart disease which may give some emphasis to this under-investigated topic.
文摘Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.
文摘Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2 has become a worldwide public health crisis.Studies have demonstrated that diabetes and dyslipidaemia are common comorbidities and could be high-risk factors for severe COVID-19.Vitamin D,a group of fatsoluble compounds responsible for intestinal absorption of calcium,magnesium,and phosphate,has been widely used as a dietary supplement for the prevention and treatment of numerous diseases,including infectious and non-infectious diseases,due to its high cost-effectiveness;safety;tolerability;and anti-thrombotic,anti-inflammatory,antiviral,and immunomodulatory properties.In this letter to the editor,we mainly discuss the potential role of vitamin D in patients with diabetes,dyslipidaemia,and COVID-19.
文摘Background The occurrence of contrast induced acute kidney injury （CIAKI） has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate （eGFR） and ejection fraction （AGEF） score （age/EF（％）＋1 （if eGFR was ＜60 ml·min-1·1.73 m2）） as an predictor of CIAKI in patients with diabetes mellitus （DM） and concomitant chronic kidney disease （CKD）.Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl （44.2 mmol/L） or 25％ above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic （ROC） analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows：AGEFlow ≤0.92 （n=1 006）; 0.92 ＜AGEFmid ≤1.16 （n=1 000）,and ACEFhigh ＞1.16 （n=992）.The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores （AGEFlow=1.1％,AGEFmid=2.3％ and AGEFhigh=5.8％,P ＜0.001）.By multivariate analysis,AGEF score was an independent predictor of CIAKI （odds ratio=4.96,95％ CI：2.32-10.58,P ＜0.01）.ROC analysis showed that the area under the curve was 0.70 （95％ CI：0.648-0.753,P ＜0.001）.Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.
文摘Two years after the coronavirus disease 2019(COVID-19)pandemic,acute hepatitis of unknown etiology in children(AHUCD)began to be reported worldwide.The novel coronavirus and adenovirus were found in pathogen and antibody tests in AHUCD cases reported by the World Health Organization.Children are not exposed to the viruses that children are generally exposed to owing to COVID-19 infection preventive measures such as isolation and wearing masks;therefore,some researchers have speculated that this disease is related to reduced exposure to pathogens.Some scientists have also speculated that the disease is related to liver injury and adenoviral hepatitis,which are the sequelae of COVID-19.Some evidence also suggests a weak association between the disease and COVID-19 vaccination.Therefore,further research and investigation of the pathogenesis,preventive measures,and early treatment of hepatitis of unknown etiology are required.This study aimed to synthesize available evidence to further elucidate this disease in order to treat and prevent it effectively.
