BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amin...BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amino acids(AAAs:Tyrosine,tryptophan,phenylalanine)show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies.However,improvement is needed to support its clinical utility.AIM To evaluate the effects of body mass index(BMI)and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight.METHODS Ninety-seven new-onset T2DM patients(<12 mo)differing in BMI[normal weight(NW),n=33,BMI=22.23±1.60;overweight,n=42,BMI=25.9±1.07;obesity(OB),n=22,BMI=31.23±2.31]from the First People’s Hospital of Yunnan Province,Kunming,China,were studied.One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs.RESULTS Fasting serum AAAs,BCAAs,glutamate,and alanine were greater and high-density lipoprotein(HDL)was lower(P<0.05,each)in OB-T2DM patients than in NW-T2DM patients,especially in male OB-T2DM patients.Arginine,histidine,leucine,methionine,and lysine were greater in male patients than in female patients.Moreover,histidine,alanine,glutamate,lysine,valine,methionine,leucine,isoleucine,tyrosine,phenylalanine,and tryptophan were significantly correlated with abdominal adiposity,body weight and BMI,whereas isoleucine,leucine and phenylalanine were negatively correlated with HDL.CONCLUSION Heterogeneously elevated amino acids,especially BCAAs/AAAs,across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development.The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals,whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals.This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.展开更多
Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical stud...Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery.Our objective was to co-mpose a narrative review that investigates COVID-19-associated NOAF,emphasi-zing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF.Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF,we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF.A comprehensive search was conducted for articles published between December 2019 and February 11,2023,focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF.Also,the latest data on incidence,morbidity-mortality,and management of NOAF in COVID-19 were investigated.Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed,mostly involving reactive oxygen pathways.With potential atrial remodeling associated with NOAF in COVID-19 patients,this group of patients might benefit from long-term follow-up and different management.Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.展开更多
AbstractAIM： To investigate the impact of minimum tacrolimus（TAC） on new-onset diabetes mellitus （NODM） afterliver transplantation （LT）.METHODS： We retrospectively analyzed the data of973 liver transplant reci...AbstractAIM： To investigate the impact of minimum tacrolimus（TAC） on new-onset diabetes mellitus （NODM） afterliver transplantation （LT）.METHODS： We retrospectively analyzed the data of973 liver transplant recipients between March 1999and September 2014 in West China Hospital LiverTransplantation Center. Following the exclusion ofineligible recipients, 528 recipients with a TAC-dominantregimen were included in our study. We calculatedand determined the mean trough concentration ofTAC （cTAC） in the year of diabetes diagnosis in NODMrecipients or in the last year of the follow-up in non-NODM recipients. A cutoff of mean cTAC value forpredicting NODM 6 mo after LT was identified usinga receptor operating characteristic curve. TAC-relatedcomplications after LT was evaluated by χ^2 test, andthe overall and allograft survival was evaluated usingthe Kaplan-Meier method. Risk factors for NODM afterLT were examined by univariate and multivariate Cox regression.RESULTS： Of the 528 transplant recipients, 131（24.8%） developed NODM after 6 mo after LT, andthe cumulative incidence of NODM progressivelyincreased. The mean cTAC of NODM group recipientswas significantly higher than that of recipients in thenon-NODM group （7.66 ± 3.41 ng/mL vs 4.47 ± 2.22ng/mL, P 〈 0.05）. Furthermore, NODM group recipientshad lower 1-, 5-, 10-year overall survival rates （86.7%,71.3%, and 61.1% vs 94.7%, 86.1%, and 83.7%, P 〈0.05） and allograft survival rates （92.8%, 84.6%, and75.7% vs 96.1%, 91%, and 86.1%, P 〈 0.05） thanthe others. The best cutoff of mean cTAC for predictingNODM was 5.89 ng/mL after 6 mo after LT. Multivariateanalysis showed that old age at the time of LT （〉 50years）, hypertension pre-LT, and high mean cTAC （≥5.89 ng/mL） after 6 mo after LT were independent riskfactors for developing NODM. Concurrently, recipientswith a low cTAC （〈 5.89 ng/mL） were less likely tobecome obese （21.3% vs 30.2%, P 〈 0.05） or todevelop dyslipidemia （27.5% vs 44.8%, P 〈0.05）,chronic kidney dysfunction （14.6% vs 22.7%, P 〈 0.05）,and moderate to severe infection （24.7% vs 33.1%, P〈 0.05） after LT than recipients in the high mean cTACgroup. However, the two groups showed no significantdifference in the incidence of acute and chronicrejection, hypertension, cardiovascular events and newonsetmalignancy.CONCLUSION： A minimal TAC regimen can decreasethe risk of long-term NODM after LT. Maintaining a cTACvalue below 5.89 ng/mL after LT is safe and beneficial.展开更多
AIM To determine the incidence and associated factors of new-onset diabetes after transplantation(NODAT) in a Portuguese central hospital. METHODS This single-center retrospective study involved consecutive adult nond...AIM To determine the incidence and associated factors of new-onset diabetes after transplantation(NODAT) in a Portuguese central hospital. METHODS This single-center retrospective study involved consecutive adult nondiabetic transplant recipients, who had undergone kidney transplantation between January 2012 and March 2016. NODAT was diagnosed according to the criteria of the American Diabetes Association. Data were collected from an institutional database of the Nephrology and Kidney Transplantation Department(Santa Maria Hospital, Lisbon, Portugal) and augmented with data of laboratorial parameters collected from the corresponding patient electronic medical records. Exclusion criteria were preexisting diabetes mellitus, missing information and follow-up period of less than 12 mo. Data on demographic and clinical characteristics as well as anthropometric and laboratorial parameters were also collected. Patients were divided into two groups: With and without NODAT-for statistical comparison.RESULTS A total of 156 patients received kidney transplantduring the study period, 125 of who were included in our analysis. NODAT was identified in 27.2% of the patients(n = 34; 53% female; mean age: 49.5 ± 10.8 years; median follow-up: 36.4 ± 2.5 mo). The incidence in the first year was 24.8%. The median time to diagnosis was 3.68 ± 5.7 mo after transplantation, and 76.5% of the patients developed NODAT in the first 3 mo. In the group that did not develop NODAT(n = 91), 47% were female, with mean age of 46.4 ± 13.5 years and median follow-up of 35.5 ± 1.6 mo. In the NODAT group, the pretransplant fasting plasma glucose(FPG) levels were significantly higher [101(96.1-105.7) mg/d L vs 92(91.4-95.8) mg/d L, P = 0.007] and pretransplant impaired fasting glucose(IFG) was significantly more frequent(51.5% vs 27.7%, P = 0.01). Higher pretransplant FPG levels and pretransplant IFG were found to be predictive risk factors for NODAT development [odds ratio(OR): 1.059, P = 0.003; OR: 2.772, P = 0.017, respectively]. CONCLUSION NODAT incidence was high in our renal transplant recipients, particularly in the first 3 mo posttransplant, and higher pretransplant FPG level and IFG were risk factors.展开更多
A diagnosis of new-onset diabetes after transplantation(NODAT) carries with it a threat to the renal allograft,as well as the same short-and long-term implications of type 2 diabetes seen in the general population.NOD...A diagnosis of new-onset diabetes after transplantation(NODAT) carries with it a threat to the renal allograft,as well as the same short-and long-term implications of type 2 diabetes seen in the general population.NODAT usually occurs early after transplantation,and is usually diagnosed according to general population guidelines.Non-modifiable risk factors for NODAT include advancing age,African American,Hispanic,or South Asian ethnicity,genetic background,a positive family history for diabetes mellitus,polycystic kidney disease,and previously diagnosed glucose intolerance.Modifiable risk factors for NODAT include obesity and the metabolic syndrome,hepatitis C virus and cytomegalovirus infection,corticosteroids,calcineurin inhibitor drugs(especially tacrolimus),and sirolimus.NODAT affects graft and patient survival,and increases the incidence of post-transplant cardiovascular disease.The incidence and impact of NODAT can be minimized through pre-and post-transplant screening to identify patients at higher risk,including by oral glucose tolerance tests,as well as multi-disciplinary care,lifestyle modification,and the use of modified immunosuppressive regimens coupled with glucose-lowering therapies including oral hypoglycemic agents and insulin.Since NODAT is a major cause of post-transplant morbidity and mortality,measures to reduce its incidence and impact have the potential to greatly improve overall transplant success.展开更多
Background: New-onset hyperglycemia(NOH) is a common phenomenon after liver transplantation(LT),but its impact on clinical outcomes has not yet been fully assessed. We aimed to evaluate the etiology and prognosis of N...Background: New-onset hyperglycemia(NOH) is a common phenomenon after liver transplantation(LT),but its impact on clinical outcomes has not yet been fully assessed. We aimed to evaluate the etiology and prognosis of NOH within 1 month after LT.Methods: The data of 3339 adult patients who underwent primary LT from donation after citizen death between January 2010 and June 2016 were extracted from China Liver Transplant Registry database and analyzed. NOH was defined as fasting blood glucose ≥7.0 mmol/L confirmed on at least two occasions within the first post-transplant month with or without hypoglycemic agent.Results: Of 3339 liver recipients, 1416(42.4%) developed NOH. Recipients with NOH had higher incidence of post-transplant complications such as graft and kidney failure, infection, biliary stricture, cholangitis,and tumor recurrence in a glucose concentration-dependent manner as compared to non-NOH recipients(P < 0.05). The independent risk factors of NOH were donor warm ischemic time >10 min, cold ischemic time >10 h, anhepatic time >60 min, recipient model for end-stage liver disease score >30, moderate ascites and corticosteroid usage(P < 0.05). Liver enzymes(alanine aminotransferase and gammaglutamyltranspeptidase) on post-transplant day 7 significantly correlated with NOH(P < 0.001).Conclusions: NOH leads to increased morbidity and mortality in liver recipients. Close surveillance and tight control of blood glucose are desiderated immediately following LT particularly in those with delayed graft function and receiving corticosteroid. Strategic targeting graft ischemic injury may help maintain glucose homeostasis.展开更多
Diabetes is a condition of persistent hyperglycemia caused by the endocrine disorder of the pancreas.Therefore,all pancreatic diseases have the risk of diabetes.In particular,increasing attention has been paid recentl...Diabetes is a condition of persistent hyperglycemia caused by the endocrine disorder of the pancreas.Therefore,all pancreatic diseases have the risk of diabetes.In particular,increasing attention has been paid recently to new-onset diabetes secondary to acute pancreatitis(AP).The complications of secondary diabetes have caused a lot of trouble for patients and have garnered increasing attention.At present,the pathophysiological mechanism of new-onset diabetes caused by AP is not clear.This review summarizes the current understanding of new-onset diabetes secondary to AP.展开更多
Organophosphate is a commonly used pesticide in the agricultural sector.The main action of organophosphate focuses on acetylcholinesterase inhibition,and it therefore contributes to acute cholinergic crisis,intermedia...Organophosphate is a commonly used pesticide in the agricultural sector.The main action of organophosphate focuses on acetylcholinesterase inhibition,and it therefore contributes to acute cholinergic crisis,intermediate syndrome and delayed neurotoxicity.From sporadic case series to epidemiologic studies,organophosphate has been linked to hyperglycemia and the occurrence of newonset diabetes mellitus.Organophosphate-mediated direct damage to pancreatic beta cells,insulin resistance related to systemic inflammation and excessive hepatic gluconeogenesis and polymorphisms of the enzyme governing organophosphate elimination are all possible contributors to the development of newonset diabetes mellitus.To date,a preventive strategy for organophosphatemediated new-onset diabetes mellitus is still lacking.However,lowering reactive oxygen species levels may be a practical method to reduce the risk of developing hyperglycemia.展开更多
Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset sei...Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. Methods: A study of an HIV-infected patient cohort on highly active anti-retroviral therapy (HAART) in the out-patients clinic of the Lagos state university teaching hospital, Nigeria. In a cross-sectional design, 308 HIV infected patients were recruited over a period of 1 year. Cases with a first seizure during this period were further examined. Details of demographic data, the first seizure date, seizure characteristics, neurologic complications and CD4 count at the time of the seizure were documented. Results: A total of 20 (6.5%) had new-onset seizures during the study period. 6/20 (30%) were males and 14/20 (70%), females. Their ages ranged between 22 - 51 years with a mean of 34.2 ± 8.7 years. The seizure was focal in 2/20 (10%) of cases and generalised in 90% (18/20) of cases. A total of 13/20 (65%) had recurrence of their seizures. None of the cases had focal neurological deficit at the time of the first seizure. The mean CD4 count was 165.3 ± 145.7. The mean duration on HAART was 19.5 ± 12.7 months. Cases with CD4 counts ≤200 cells/mm3 constituted 70% (14/20) whilst those with CD4 counts >200 made up 30% (6/20) [p = 0.666]. Conclusions: Seizures remain a significant neurological manifestation of HIV infection and has a high recurrence rate. It occurs more commonly in the advanced stage with severe immune suppression and may be attributable to HIV encephalopathy. Early treatment would reduce the burden and improve patient’s quality of life.展开更多
We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults.A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutri...We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults.A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included.Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory.Participants with systolic blood pressure≥140 mmHg or diastolic blood pressure≥90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension.During a median follow-up duration of 6.1 years,4269 participants developed new-onset hypertension.Overall,the association between dietary zinc intake and new-onset hypertension followed a J-shape(P for non-linearity<0.001).The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake(per mg/day:hazard ratio(HR)0.93;95%confidence interval(CI)0.88–0.98)in participants with zinc intake<10.9 mg/day,and increased with the increment of zinc intake(per mg/day:HR 1.14;95%CI 1.11–1.16)in participants with zinc intake≥10.9 mg/day.In conclusion,there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults,with an inflection point at about 10.9 mg/day.展开更多
Background:Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels.However,the use of statins leads to an increased incidence of new-on...Background:Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels.However,the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus(NODM).Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome(ACS)who underwent percutaneous coronary intervention(PCI)within 18 months of follow-up.Methods:A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June 2017.The survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the endpoint.Cox proportional hazards models were used to calculate hazard ratios(HRs)and 95%confidence intervals(CIs)for the risk factors of NODM.Results:In total,220 patients received rosuvastatin and 168 atorvastatin.The cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance,compared with that in the atorvastatin group(7.27%vs.12.50%,respectively;log-rank P=0.08).Using Cox proportional hazards models,baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM(HR:4.56;95%CI:2.83–7.36;P<0.01).Conclusion:Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.展开更多
基金Supported by the Open Project Grant for Clinical Medical Center of Yunnan Province,No.2019LCZXKF-NM03Medical Leader Training Grant,No.L-201624and Yunnan Province Ten Thousand Talents:“Medical Expert”grant,No.YNWR-MY-2019-020.
文摘BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amino acids(AAAs:Tyrosine,tryptophan,phenylalanine)show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies.However,improvement is needed to support its clinical utility.AIM To evaluate the effects of body mass index(BMI)and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight.METHODS Ninety-seven new-onset T2DM patients(<12 mo)differing in BMI[normal weight(NW),n=33,BMI=22.23±1.60;overweight,n=42,BMI=25.9±1.07;obesity(OB),n=22,BMI=31.23±2.31]from the First People’s Hospital of Yunnan Province,Kunming,China,were studied.One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs.RESULTS Fasting serum AAAs,BCAAs,glutamate,and alanine were greater and high-density lipoprotein(HDL)was lower(P<0.05,each)in OB-T2DM patients than in NW-T2DM patients,especially in male OB-T2DM patients.Arginine,histidine,leucine,methionine,and lysine were greater in male patients than in female patients.Moreover,histidine,alanine,glutamate,lysine,valine,methionine,leucine,isoleucine,tyrosine,phenylalanine,and tryptophan were significantly correlated with abdominal adiposity,body weight and BMI,whereas isoleucine,leucine and phenylalanine were negatively correlated with HDL.CONCLUSION Heterogeneously elevated amino acids,especially BCAAs/AAAs,across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development.The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals,whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals.This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.
文摘Over the last three years,research has focused on examining cardiac issues arising from coronavirus disease 2019(COVID-19)infection,including the emergence of new-onset atrial fibrillation(NOAF).Still,no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery.Our objective was to co-mpose a narrative review that investigates COVID-19-associated NOAF,emphasi-zing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF.Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF,we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF.A comprehensive search was conducted for articles published between December 2019 and February 11,2023,focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF.Also,the latest data on incidence,morbidity-mortality,and management of NOAF in COVID-19 were investigated.Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed,mostly involving reactive oxygen pathways.With potential atrial remodeling associated with NOAF in COVID-19 patients,this group of patients might benefit from long-term follow-up and different management.Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.
基金Supported by Key Technology Support Program of Sichuan ProvinceNo.2013SZ0023
文摘AbstractAIM： To investigate the impact of minimum tacrolimus（TAC） on new-onset diabetes mellitus （NODM） afterliver transplantation （LT）.METHODS： We retrospectively analyzed the data of973 liver transplant recipients between March 1999and September 2014 in West China Hospital LiverTransplantation Center. Following the exclusion ofineligible recipients, 528 recipients with a TAC-dominantregimen were included in our study. We calculatedand determined the mean trough concentration ofTAC （cTAC） in the year of diabetes diagnosis in NODMrecipients or in the last year of the follow-up in non-NODM recipients. A cutoff of mean cTAC value forpredicting NODM 6 mo after LT was identified usinga receptor operating characteristic curve. TAC-relatedcomplications after LT was evaluated by χ^2 test, andthe overall and allograft survival was evaluated usingthe Kaplan-Meier method. Risk factors for NODM afterLT were examined by univariate and multivariate Cox regression.RESULTS： Of the 528 transplant recipients, 131（24.8%） developed NODM after 6 mo after LT, andthe cumulative incidence of NODM progressivelyincreased. The mean cTAC of NODM group recipientswas significantly higher than that of recipients in thenon-NODM group （7.66 ± 3.41 ng/mL vs 4.47 ± 2.22ng/mL, P 〈 0.05）. Furthermore, NODM group recipientshad lower 1-, 5-, 10-year overall survival rates （86.7%,71.3%, and 61.1% vs 94.7%, 86.1%, and 83.7%, P 〈0.05） and allograft survival rates （92.8%, 84.6%, and75.7% vs 96.1%, 91%, and 86.1%, P 〈 0.05） thanthe others. The best cutoff of mean cTAC for predictingNODM was 5.89 ng/mL after 6 mo after LT. Multivariateanalysis showed that old age at the time of LT （〉 50years）, hypertension pre-LT, and high mean cTAC （≥5.89 ng/mL） after 6 mo after LT were independent riskfactors for developing NODM. Concurrently, recipientswith a low cTAC （〈 5.89 ng/mL） were less likely tobecome obese （21.3% vs 30.2%, P 〈 0.05） or todevelop dyslipidemia （27.5% vs 44.8%, P 〈0.05）,chronic kidney dysfunction （14.6% vs 22.7%, P 〈 0.05）,and moderate to severe infection （24.7% vs 33.1%, P〈 0.05） after LT than recipients in the high mean cTACgroup. However, the two groups showed no significantdifference in the incidence of acute and chronicrejection, hypertension, cardiovascular events and newonsetmalignancy.CONCLUSION： A minimal TAC regimen can decreasethe risk of long-term NODM after LT. Maintaining a cTACvalue below 5.89 ng/mL after LT is safe and beneficial.
文摘AIM To determine the incidence and associated factors of new-onset diabetes after transplantation(NODAT) in a Portuguese central hospital. METHODS This single-center retrospective study involved consecutive adult nondiabetic transplant recipients, who had undergone kidney transplantation between January 2012 and March 2016. NODAT was diagnosed according to the criteria of the American Diabetes Association. Data were collected from an institutional database of the Nephrology and Kidney Transplantation Department(Santa Maria Hospital, Lisbon, Portugal) and augmented with data of laboratorial parameters collected from the corresponding patient electronic medical records. Exclusion criteria were preexisting diabetes mellitus, missing information and follow-up period of less than 12 mo. Data on demographic and clinical characteristics as well as anthropometric and laboratorial parameters were also collected. Patients were divided into two groups: With and without NODAT-for statistical comparison.RESULTS A total of 156 patients received kidney transplantduring the study period, 125 of who were included in our analysis. NODAT was identified in 27.2% of the patients(n = 34; 53% female; mean age: 49.5 ± 10.8 years; median follow-up: 36.4 ± 2.5 mo). The incidence in the first year was 24.8%. The median time to diagnosis was 3.68 ± 5.7 mo after transplantation, and 76.5% of the patients developed NODAT in the first 3 mo. In the group that did not develop NODAT(n = 91), 47% were female, with mean age of 46.4 ± 13.5 years and median follow-up of 35.5 ± 1.6 mo. In the NODAT group, the pretransplant fasting plasma glucose(FPG) levels were significantly higher [101(96.1-105.7) mg/d L vs 92(91.4-95.8) mg/d L, P = 0.007] and pretransplant impaired fasting glucose(IFG) was significantly more frequent(51.5% vs 27.7%, P = 0.01). Higher pretransplant FPG levels and pretransplant IFG were found to be predictive risk factors for NODAT development [odds ratio(OR): 1.059, P = 0.003; OR: 2.772, P = 0.017, respectively]. CONCLUSION NODAT incidence was high in our renal transplant recipients, particularly in the first 3 mo posttransplant, and higher pretransplant FPG level and IFG were risk factors.
文摘A diagnosis of new-onset diabetes after transplantation(NODAT) carries with it a threat to the renal allograft,as well as the same short-and long-term implications of type 2 diabetes seen in the general population.NODAT usually occurs early after transplantation,and is usually diagnosed according to general population guidelines.Non-modifiable risk factors for NODAT include advancing age,African American,Hispanic,or South Asian ethnicity,genetic background,a positive family history for diabetes mellitus,polycystic kidney disease,and previously diagnosed glucose intolerance.Modifiable risk factors for NODAT include obesity and the metabolic syndrome,hepatitis C virus and cytomegalovirus infection,corticosteroids,calcineurin inhibitor drugs(especially tacrolimus),and sirolimus.NODAT affects graft and patient survival,and increases the incidence of post-transplant cardiovascular disease.The incidence and impact of NODAT can be minimized through pre-and post-transplant screening to identify patients at higher risk,including by oral glucose tolerance tests,as well as multi-disciplinary care,lifestyle modification,and the use of modified immunosuppressive regimens coupled with glucose-lowering therapies including oral hypoglycemic agents and insulin.Since NODAT is a major cause of post-transplant morbidity and mortality,measures to reduce its incidence and impact have the potential to greatly improve overall transplant success.
基金supported by grants from the National Natural Science Foundation of China(81771713,81470892,and 81570589)Zhejiang Natural Science Foundation(LY17H100003)Zhejiang Science and Technology Key Research and Development Project(2018C04010)
文摘Background: New-onset hyperglycemia(NOH) is a common phenomenon after liver transplantation(LT),but its impact on clinical outcomes has not yet been fully assessed. We aimed to evaluate the etiology and prognosis of NOH within 1 month after LT.Methods: The data of 3339 adult patients who underwent primary LT from donation after citizen death between January 2010 and June 2016 were extracted from China Liver Transplant Registry database and analyzed. NOH was defined as fasting blood glucose ≥7.0 mmol/L confirmed on at least two occasions within the first post-transplant month with or without hypoglycemic agent.Results: Of 3339 liver recipients, 1416(42.4%) developed NOH. Recipients with NOH had higher incidence of post-transplant complications such as graft and kidney failure, infection, biliary stricture, cholangitis,and tumor recurrence in a glucose concentration-dependent manner as compared to non-NOH recipients(P < 0.05). The independent risk factors of NOH were donor warm ischemic time >10 min, cold ischemic time >10 h, anhepatic time >60 min, recipient model for end-stage liver disease score >30, moderate ascites and corticosteroid usage(P < 0.05). Liver enzymes(alanine aminotransferase and gammaglutamyltranspeptidase) on post-transplant day 7 significantly correlated with NOH(P < 0.001).Conclusions: NOH leads to increased morbidity and mortality in liver recipients. Close surveillance and tight control of blood glucose are desiderated immediately following LT particularly in those with delayed graft function and receiving corticosteroid. Strategic targeting graft ischemic injury may help maintain glucose homeostasis.
文摘Diabetes is a condition of persistent hyperglycemia caused by the endocrine disorder of the pancreas.Therefore,all pancreatic diseases have the risk of diabetes.In particular,increasing attention has been paid recently to new-onset diabetes secondary to acute pancreatitis(AP).The complications of secondary diabetes have caused a lot of trouble for patients and have garnered increasing attention.At present,the pathophysiological mechanism of new-onset diabetes caused by AP is not clear.This review summarizes the current understanding of new-onset diabetes secondary to AP.
基金Chang Gung Memorial Hospital,Linkou,Taiwan,No.CORPG3K0191 and No.CMRPG3J1051-3.
文摘Organophosphate is a commonly used pesticide in the agricultural sector.The main action of organophosphate focuses on acetylcholinesterase inhibition,and it therefore contributes to acute cholinergic crisis,intermediate syndrome and delayed neurotoxicity.From sporadic case series to epidemiologic studies,organophosphate has been linked to hyperglycemia and the occurrence of newonset diabetes mellitus.Organophosphate-mediated direct damage to pancreatic beta cells,insulin resistance related to systemic inflammation and excessive hepatic gluconeogenesis and polymorphisms of the enzyme governing organophosphate elimination are all possible contributors to the development of newonset diabetes mellitus.To date,a preventive strategy for organophosphatemediated new-onset diabetes mellitus is still lacking.However,lowering reactive oxygen species levels may be a practical method to reduce the risk of developing hyperglycemia.
文摘Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. Methods: A study of an HIV-infected patient cohort on highly active anti-retroviral therapy (HAART) in the out-patients clinic of the Lagos state university teaching hospital, Nigeria. In a cross-sectional design, 308 HIV infected patients were recruited over a period of 1 year. Cases with a first seizure during this period were further examined. Details of demographic data, the first seizure date, seizure characteristics, neurologic complications and CD4 count at the time of the seizure were documented. Results: A total of 20 (6.5%) had new-onset seizures during the study period. 6/20 (30%) were males and 14/20 (70%), females. Their ages ranged between 22 - 51 years with a mean of 34.2 ± 8.7 years. The seizure was focal in 2/20 (10%) of cases and generalised in 90% (18/20) of cases. A total of 13/20 (65%) had recurrence of their seizures. None of the cases had focal neurological deficit at the time of the first seizure. The mean CD4 count was 165.3 ± 145.7. The mean duration on HAART was 19.5 ± 12.7 months. Cases with CD4 counts ≤200 cells/mm3 constituted 70% (14/20) whilst those with CD4 counts >200 made up 30% (6/20) [p = 0.666]. Conclusions: Seizures remain a significant neurological manifestation of HIV infection and has a high recurrence rate. It occurs more commonly in the advanced stage with severe immune suppression and may be attributable to HIV encephalopathy. Early treatment would reduce the burden and improve patient’s quality of life.
基金the National Institute for Nutrition and Health,China Center for Disease Control and Prevention,Carolina Population Center(P2C HD050924 and T32 HD007168)the University of North Carolina at Chapel Hill,the National Institutes of Health(NIH+3 种基金R01-HD30880,DK056350,R24 HD050924,and R01-HD38700)the NIH Fogarty International Center(D43 TW009077 and D43 TW007709)for financial support for the CHNS data collection and analysis files from 1989 to 2015 and future surveys,and the China-Japan Friendship Hospital,Ministry of Health for support for CHNS 2009,Chinese National Human Genome Center at Shanghai since 2009,and Beijing Municipal Center for Disease Prevention and Control since 2011The study was supported by the National Key Research and Development Program(Nos.2022YFC2009600 and 2022YFC2009605)the National Natural Science Foundation of China(Nos.81973133 and 81730019).
文摘We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults.A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included.Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory.Participants with systolic blood pressure≥140 mmHg or diastolic blood pressure≥90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension.During a median follow-up duration of 6.1 years,4269 participants developed new-onset hypertension.Overall,the association between dietary zinc intake and new-onset hypertension followed a J-shape(P for non-linearity<0.001).The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake(per mg/day:hazard ratio(HR)0.93;95%confidence interval(CI)0.88–0.98)in participants with zinc intake<10.9 mg/day,and increased with the increment of zinc intake(per mg/day:HR 1.14;95%CI 1.11–1.16)in participants with zinc intake≥10.9 mg/day.In conclusion,there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults,with an inflection point at about 10.9 mg/day.
基金the National Natural Science Foundation of China(82070388)the Taishan Pandeng Scholar Program of Shandong Province(tspd20181220)the National Natural Science Foundation of Shandong Province(ZR2020MH035).
文摘Background:Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels.However,the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus(NODM).Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome(ACS)who underwent percutaneous coronary intervention(PCI)within 18 months of follow-up.Methods:A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June 2017.The survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the endpoint.Cox proportional hazards models were used to calculate hazard ratios(HRs)and 95%confidence intervals(CIs)for the risk factors of NODM.Results:In total,220 patients received rosuvastatin and 168 atorvastatin.The cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance,compared with that in the atorvastatin group(7.27%vs.12.50%,respectively;log-rank P=0.08).Using Cox proportional hazards models,baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM(HR:4.56;95%CI:2.83–7.36;P<0.01).Conclusion:Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.
基金Source of Support： This study was partly supported by grants from the National Natural Science Foundation of China （No. 30900618, No. 81270245）. Conflict of Interest： None declared.
文摘目的·了解新冠疫情大流行期间儿童及青少年的新发焦虑症状,分析影响该症状的相关因素。方法·依托成都儿童正向成长(Chengdu Positive Child Development,CPCD)队列,纳入成都市5所中小学的儿童和青少年共5566例,分别建立儿童和青少年新发焦虑症状纵向研究队列并开展2轮调查。第一轮调查(基线调查)的时间为2019年12月—2020年1月,通过促进儿童青少年正面成长研究学生调查问卷收集队列成员的一般人口学特征信息;第二轮调查(随访调查)的时间为2020年2—7月,补充收集队列成员的新冠病毒感染史,以及饮食、学习、社交和娱乐活动是否受到新冠疫情的影响等信息。利用儿童焦虑性情绪障碍筛查表(Screen for Child Anxiety Related Emotional Disorders,SCARED)评估所有研究对象的新发焦虑症状。采用多因素Logistic回归模型对儿童和青少年新发焦虑症状的影响因素进行分析。结果·SCARED评估结果显示,在新冠疫情大流行期间成都儿童及青少年新发焦虑症状的发病率为13.47%;其中儿童新发焦虑症状纵向研究队列中的发病率为11.91%,青少年新发焦虑症状纵向研究队列中的发病率为14.25%。χ^(2)检验的结果显示,儿童新发焦虑症状的发病率在年龄、本人或家人是否感染新冠病毒,以及饮食、学习和社交活动是否受到影响间的差异具有统计学意义(均P<0.05);青少年新发焦虑症状的发病率在性别、年级、年龄、居住地区,以及饮食、学习、社交和娱乐活动是否受到影响间差异亦具有统计学意义(均P<0.05)。多因素Logistic回归分析的结果显示:对儿童来说,6~8岁是其新发焦虑症状的保护因素,而本人或家人感染过新冠病毒、学习活动受到影响是其危险因素(均P<0.05);对青少年来说,男性、居住在城镇、年级≤6是其新发焦虑症状的保护因素,而学习活动受到影响是其危险因素(均P<0.05)。结论·对于儿童和青少年来说,在新冠大流行期间影响其新发焦虑症状的因素并不完全一致;对于儿童来说,年龄、本人或家人是否感染新冠病毒、学习是否受到影响是其新发焦虑症状的独立影响因素,但对青少年来说则是性别、年级、居住地区和学习是否受到影响。因此,在动态关注儿童和青少年心理健康状态、持续做好心理健康干预工作过程中,应遵循成长规律,充分考虑儿童和青少年的发展特点,采取不同的策略和措施。
