Circadian Rhythm of Blood Pressure Challenges Office Values as the “Gold Standard” in the Diagnosis of Gestational Hypertension

Despite poor sensitivity and specificity, office blood pressure (BP) determinations are still the “gold standard” for diagnosing gestational hypertension. This prospective blind study evaluates the prognostic value of office values as compared with ambulatory monitoring in pregnancy. We analyzed 2175 BP series systematically sampled from 355 non-preeclamptic pregnant women for 48 h every 4 wks from the first hospital visit until delivery. Women were divided for comparative purposes into three groups: “detected” gestational hypertension, defined on the basis of casual clinical BP>140/90 mm Hg after 20 wks of gestation and hyperbaric index (area of BP excess above the upper limit of a time-specified tolerance interval adjusted for the circadian pattern of the reference population) consistently above the threshold for diagnosing hypertension in pregnancy; “undetected” gestational hypertension, women with office BP<140/90 mm Hg but hyperbaric index consistently above the threshold for diagnosis; and normotension, women with both office values and hyperbaric index below the respective thresholds for diagnosis. Small and insignificant differences in the 24 h mean BP between “detected” and “undetected” gestational hypertension is observed in all trimesters, in contrast with highly significant differences between these two groups and normotensive pregnancies. Normotensive women are characterized by highly significant lesser incidence by 60% in preterm delivery, 70% in intrauterine growth retardation, and 50% in delivery by cesarean section (P<0.001) compared with women with “detected” and “undetected” gestational hypertension (P>0.715). In pregnancy, the hyperbaric index is markedly superior to office BP measurements for diagnosis of what should be truly considered gestational hypertension, and for prediction of the outcome of pregnancy.     

Prolonged gene expression in primary porcine pancreatic cells using an Epstein-Barr virus-based episomal vector

Epstein-Barr virus (EBV)-based plasmids containing the origin of replication (oriP) and EBV nuclear antigen 1 (EBNA-1) are well known for the stable episomal maintenance in human cells. In order to clarify whether an EBV-based plasmid can be maintained stably in the porcine pancreatic cells which are the primary candidate sources of islet xenotransplantation, we constructed pEBVGFP encoding the green fluorescent protein (GFP). Monolayer culture of the porcine neonatal pancreatic cells was lipofected with pEBVGFP or pGFP which was derived from pEBVGFP by deleting out oriP and EBNA-1. pEBVGFP significantly prolonged GFP expression not only in human cell lines but also in the primary porcine pancreatic cells compared with pGFP. Interestingly, the duct cells that are believed as the pancreatic precursor cells were preferentially transfected and conveniently enriched among the mixed primary cell populations using a hygromycin B selection. To our knowledge, this is the first report suggesting the potential application of an EBV-based plasmid for the extended gene expression in the primary porcine pancreatic duct cells.     

Is oxidative stress induced by iron status associated with gestational diabetes mellitus?

Gestational diabetes mellitus (GDM) is a common pregnancy complication in high risk populations, and is associated with increased perinatal and long term outcomes for both mothers and newborns. Both its prevention and early management can be reinforced by identifying risks factors, particularly those factors influencing glucose metabolism. On the other hand, several epidemiological studies have shown an increased oxidative stress (OS) in pregnant women with GDM. Elevated OS was also reported in pregnant women supplemented with iron, which can generate OS and may also influence insulin resistance. This review summarizes the current state of knowledge, highlighting the potential relationship between OS induced by iron status and the development of GDM.     

糖尿病合并肺结核患者诱导耐药性危险因素的回归分析

目的:研究2型糖尿病(Type 2 Diabetes,T2DM)合并肺结核(Tuberculosis,TB)患者诱导耐药性危险因素的回归分析。方法:从2012年3月到2013年3月,于我院共计有124例患者被确诊为肺结核,将其作为研究对象。根据患者是否合并有2型糖尿病,将其分成观察组(49例)及对照组(75例)。对全部患者进行耐药性实验,分别经单因素分析及Logistic回归性分析寻找诱导耐药性的危险因素。结果:观察组在治疗过程中断、有吸烟习惯、依从性差、病程≥1年、HbAlc值≥6.5%等方面所占比例显著高于对照组,差异均有统计学意义(均P0.05)。由多因素分析可知,治疗过程中断、有吸烟习惯、依从性差、病程≥1年、HbAlc值≥6.5%等均为糖尿病合并肺结核患者的危险因素。结论:T2DM合并TB患者诱导耐药性的危险因素较多,临床应重点关注,并采取相应措施,从而为临床治疗提供更为有利的条件。     

糖化血清白蛋白检测对2型糖尿病患者短期血糖控制的疗效评价(英文)

目的:探讨糖化血清白蛋白(glycate dalbumin,GA)作为反映近期(2周内)血糖控制总体水平的指标在糖尿病人群中的临床应用价值。方法:选取2010年6月-2013年7月间深圳市福田区中医院住院的2型糖尿病(T2DM)患者323例,测定空腹血糖(FPG)、餐后2小时血糖(2hPG)、1日指尖血糖谱均值(MBG)、GA、糖化血红蛋白(HbAlc)等,并对其中92例住院近2周的患者分别在入院后6天及12天复查上述指标。结果:GA与HbAlc(r=0.791),FPG(r=0.541),2hPG(r=0.456),MBG(r=0.401),均呈正相关(P均0.01);患者入院6天检测GA为(27.1±5.45)%,入院12天为(22.77±4.34)%,均显著低于入院第一天的(30.31±6.75)%(P0.01);入院6天和12天,患者的GA较入院时分别下降3.12%和7.54%(P0.01);HbAlC分别下降0.31%和0.78%,GA下降降幅显著大于HbAlc(P0.01)。结论:GA可及时、准确的反映短期(1~2周)平均血糖的变化情况,并与长期血糖控制的金标准HbAlC有良好的相关性,是监测糖尿病患者血糖控制的良好指标。     

血清同型半胱氨酸、脂联素、高敏C反应蛋白水平与颈动脉内膜中层厚度在老年2型糖尿病合并脑梗死患者中的意义

目的：观察血清同型半胱氨酸（Hcy）、脂联素（APN）、高敏C反应蛋白（hs．CRP）水平与颈动脉内膜中层厚度（1MT）在老年2型糖尿病合并脑梗死患者中的意义。方法：选择2008年5月至2012年5月在我院就诊的2型糖尿病患者218例,按照是否合并脑梗死分为糖尿病伴脑梗死组（105例）和单纯糖尿病组（113例）。选择同期健康体检者30例为健康对照组。观察三组血清Hcy、APN、hs—CRP和IMT的水平变化。结果：糖尿病伴脑梗死组和单纯糖尿病组的血清Hcy、hs—CRP和IMT的水平均较正常对照组明显提高（P〈0．01）,糖尿病伴脑梗死组以上指标显著高于单纯糖尿病组（P〈0．01）;而糖尿病伴脑梗死组和单纯糖尿病组的血清APN的水平较正常对照组明显降低（P〈0．01）,糖尿病伴脑梗死组血清APN的水平较单纯糖尿病组显著降低（P〈0．01）。血清Hcy和hs—CRP水平随着1MT的严重程度增加而升高（P〈0．01）,而APN水平随着IMT严重程度升高而降低（P〈0．01）。结论：糖尿病伴脑梗死的患者大血管病变较单纯糖尿病患者更为严重,颈动脉IMT与Hcy和hs—cRP呈正相关,而与APN呈负相关。     

Phosphorylation and Degradation of Tomosyn-2 De-represses Insulin Secretion

The abundance and functional activity of proteins involved in the formation of the SNARE complex are tightly regulated for efficient exocytosis. Tomosyn proteins are negative regulators of exocytosis. Tomosyn causes an attenuation of insulin secretion by limiting the formation of the SNARE complex. We hypothesized that glucose-dependent stimulation of insulin secretion from β-cells must involve reversing the inhibitory action of tomosyn. Here, we show that glucose increases tomosyn protein turnover. Within 1 h of exposure to 15 mm glucose, ∼50% of tomosyn was degraded. The degradation of tomosyn in response to high glucose was blocked by inhibitors of the proteasomal pathway. Using ³²P labeling and mass spectrometry, we showed that tomosyn-2 is phosphorylated in response to high glucose, phorbol esters, and analogs of cAMP, all key insulin secretagogues. We identified 11 phosphorylation sites in tomosyn-2. Site-directed mutagenesis was used to generate phosphomimetic (Ser → Asp) and loss-of-function (Ser → Ala) mutants. The Ser → Asp mutant had enhanced protein turnover compared with the Ser → Ala mutant and wild type tomosyn-2. Additionally, the Ser → Asp tomosyn-2 mutant was ineffective at inhibiting insulin secretion. Using a proteomic screen for tomosyn-2-binding proteins, we identified Hrd-1, an E3-ubiquitin ligase. We showed that tomosyn-2 ubiquitination is increased by Hrd-1, and knockdown of Hrd-1 by short hairpin RNA resulted in increased abundance in tomosyn-2 protein levels. Taken together, our results reveal a mechanism by which enhanced phosphorylation of a negative regulator of secretion, tomosyn-2, in response to insulin secretagogues targets it to degradation by the Hrd-1 E3-ubiquitin ligase.     

Contribution of Residue B5 to the Folding and Function of Insulin and IGF-I: CONSTRAINTS AND FINE-TUNING IN THE EVOLUTION OF A PROTEIN FAMILY*

Proinsulin exhibits a single structure, whereas insulin-like growth factors refold as two disulfide isomers in equilibrium. Native insulin-related growth factor (IGF)-I has canonical cystines (A6—A11, A7–B7, and A20—B19) maintained by IGF-binding proteins; IGF-swap has alternative pairing (A7–A11, A6—B7, and A20—B19) and impaired activity. Studies of mini-domain models suggest that residue B5 (His in insulin and Thr in IGFs) governs the ambiguity or uniqueness of disulfide pairing. Residue B5, a site of mutation in proinsulin causing neonatal diabetes, is thus of broad biophysical interest. Here, we characterize reciprocal B5 substitutions in the two proteins. In insulin, His^B5 → Thr markedly destabilizes the hormone (ΔΔG_u 2.0 ± 0.2 kcal/mol), impairs chain combination, and blocks cellular secretion of proinsulin. The reciprocal IGF-I substitution Thr^B5 → His (residue 4) specifies a unique structure with native ¹H NMR signature. Chemical shifts and nuclear Overhauser effects are similar to those of native IGF-I. Whereas wild-type IGF-I undergoes thiol-catalyzed disulfide exchange to yield IGF-swap, His^B5-IGF-I retains canonical pairing. Chemical denaturation studies indicate that His^B5 does not significantly enhance thermodynamic stability (ΔΔG_u 0.2 ± 0.2 kcal/mol), implying that the substitution favors canonical pairing by destabilizing competing folds. Whereas the activity of Thr^B5-insulin is decreased 5-fold, His^B5-IGF-I exhibits 2-fold increased affinity for the IGF receptor and augmented post-receptor signaling. We propose that conservation of Thr^B5 in IGF-I, rescued from structural ambiguity by IGF-binding proteins, reflects fine-tuning of signal transduction. In contrast, the conservation of His^B5 in insulin highlights its critical role in insulin biosynthesis.