Racial and Ethnic Disparities in Diabetes Clinical Care and Management: A Narrative Review

Diabetes affects nearly 37 million Americans, with disproportionately higher disease burden amongst those from minoritized communities. The result of this is greater rates of diabetic complications and mortality. To close this gap in care, it is important to assess the differences in both diagnosis and care between White and ethnic/racial minoritized persons with diabetes. The purpose of this narrative review is to explore this further by assessing the differences in diagnosis, management, diabetes education, and complications.     

Nox4 and diabetic nephropathy: With a friend like this,who needs enemies?

Oxidative stress has been linked to the pathogenesis of diabetic nephropathy, a complication of diabetes in the kidney. NADPH oxidases of the Nox family are a major source of reactive oxygen species in the diabetic kidney and are critical mediators of redox signaling in glomerular and tubulointerstitial cells exposed to the diabetic milieu. Here, we present an overview of the current understanding of the roles of Nox catalytic and regulatory subunits in the processes that control mesangial cell, podocyte, and tubulointerstitial cell injury induced by hyperglycemia and other predominant factors enhanced in the diabetic milieu, including the renin–angiotensin system and transforming growth factor-β. The role of the Nox isoform Nox4 in the redox processes that alter renal biology in diabetes is highlighted.     

右美托咪定辅助麻醉对老年腹部重症病患术后谵妄以及Ramsay镇静评分的影响

目的:探讨右美托咪定辅助麻醉对老年腹部重症病患术后谵妄以及Ramsay镇静评分的影响。方法:将2018年6月-2019年6月我院收治入院的48例拟行手术的老年腹部重症患者为研究对象,随机分为观察组和对照组各24例,分别给予负荷剂量1μg/kg右美托咪定和等量盐水注入。术中观察组继续泵入右美托咪定0.2μg/(kg·h),对照组输注等量生理盐水。记录不同时间段神经元特异性烯醇化酶(NSE)、血清S100β蛋白、白细胞介素-1β(IL-1β)及肿瘤坏死因子-α(TNF-α)的浓度,拔管时间,苏醒时间,术后1、2、3d谵妄发生情况及术后不同时间段的Ramsay镇静评分。结果:T0时,两组NSE、血清S100蛋白、TNF-α及IL-1β的浓度比较,差异均无统计学意义(P0.05);T1-T3时,两组NSE、血清S100蛋白、TNF-α及IL-1β的浓度持续升高,且观察组NSE、血清S100蛋白、TNF-α及IL-1β的浓度均低于对照组,差异均有统计学意义(P0.05);T4时,两组均显著下降,且观察组低于对照组,差异均有统计学意义(P0.05)。观察组患者拔管时间及苏醒时间均短于对照组,差异均有统计学意义(P0.05)。观察组患者在术后谵妄总发生率少于对照组,差异有统计学意义(P0.05)。与术后30 min时相比,两组术后1 h、6 h、12 h、24 h、48 h时均显著降低,且观察组在术后30 min、1 h、6 h、12 h、24 h、48 h均低于对照组,差异均有统计学意义(P0.05)。结论:右美托咪定辅助麻醉应用于老年腹部重症患者,可保持患者心率及平均动脉压平稳,缩短拔管时间及苏醒时间,减少术后谵妄发生情况,且缩短谵妄发生时间,值得临床推广普及。     

HLA-A2 Antigen status predicts metastasis and response to immunotherapy in gastric cancer

 Our previous studies have shown that HLA-DR4 and -B52 antigens are associated with an increased risk of lymph node metastasis in patients with gastric cancer. We hypothesized that a putative HLA antigen, correlated with a low risk of lymph node metastasis, may also be correlated with the response to anticancer therapy. The microcytotoxicity assay was used to examine 49 HLA antigens of the A, B, C, DR, and DQ loci, and the association between HLA class I and II antigen status and lymph node metastasis in 847 patients with gastric cancer as well as the response to the therapy in 739 patients were analyzed. HLA-A2 antigen was significantly associated with a low risk of lymph node metastasis in patients with T2-T4 advanced cancer [58.8% compared to 37.0% in patients with lymph node metastasis; corrected P, P _c (98), =0.011], especially in those with moderately differentiated adenocarcinoma [71.0% compared to 26.4% in patients with lymph node metastasis, P _c (294)=0.00294] and with a better response to postoperative immunotherapy using protein-bound polysaccharide K (PSK), a nonspecific immunomodulator, than to chemotherapy. HLA alleles may be associated with resistance or susceptibility to lymph node metastasis and HLA-A2 antigen may be a useful predictor of the response to PSK. The data suggest that the predictive power of this HLA antigen may prove useful in the selection of anticancer therapy. Received: 29 May 1997 / Accepted: 15 July 1997     

外泌体微小RNA在糖尿病并发症中的作用及其运动干预

糖尿病是临床常见的代谢性疾病，其破坏性大血管并发症及微血管并发症是导致患者生活质量下降乃至死亡的主要原因之一。因此，探究其发病机理对于糖尿病的诊断和治疗具有重要意义。外泌体（exosomes，EXs）是一种能被多种细胞分泌，并能通过其携带的生物活性分子，如微小RNA（microRNAs，miRNA）、蛋白质、脂质等实现细胞间信息交流的囊泡小体。已有报道表明，运动可促进EXs释放并通过其携带的miRNA在糖尿病并发症中发挥有益效应。本文就EXs miRNA在糖尿病并发症中的作用、不同运动方式对EXs miRNA的影响以及运动介导EXs miRNA调控糖尿病并发症潜在机制的研究进展进行阐述，以期为运动防治糖尿病并发症的靶点筛选及预后诊断提供新思路。     

Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit,oncologic outcomes and incidence of gastrointestinal and urinary toxicities

AimThe purpose of this study was to review genitourinary (GU) and gastrointestinal (GI) toxicity associated with high-dose radiotherapy (RT) delivered with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) or volumetric arc therapy (VMAT) following radical prostatectomy (RP).BackgroundRP is a therapeutic option for the management of prostate cancer (PrCa). When assessing postoperative RT techniques for PrCa, the published literature focuses on patients treated with 2-dimensional conventional methods without reflecting the implementation of 3D-CRT, IMRT, or VMAT.Materials and methodsA total of 83 patients were included in this analysis; 30 patients received 3D-CRT, and 53 patients received IMRT/VMAT. Acute and late symptoms of the GU and lower GI tract were retrospectively graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer radiation toxicity grading systems. The relapse failure-free rate and overall survival were also evaluated.ResultsThe rate of acute GU toxicity was 9.4% vs. 13.3% for the IMRT/VMAT and 3D-CRT groups (p = 0.583). The 5-year actuarial rates of late GI toxicity for IMRT/VMAT and 3D-CRT treatments were 1.9% and 6.7%, respectively. The rate of late GU toxicity for the IMRT/VMAT and 3D-CRT treatment groups was 7.5% and 16.6%, respectively (p = 0.199). We found no association between acute or late toxicity and the RT technique in univariate and multivariate analyses.ConclusionPostprostatectomy IMRT/VMAT and 3D-CRT achieved similar morbidity and cancer control outcomes. The clinical benefit of highly conformal techniques in this setting is unclear although formal analysis is needed.     

Rhinosporidiosis in man: Case reports

Three cases of rhinosporidiosis with complications, hitherto not reported, are presented. Frog-faced deformity and seizures were observed in one case, excessive bleeding, loss of olfactory sensation and septal perforation were noticed in the second case, while the third one exhibited a disseminated type of the disease. Clinical findings of these cases are discussed.     

Association Between Non-Alcoholic Fatty Liver Disease and Diabetes-Related Microvascular Complications: A Retrospective Cross-Sectional Study of Hospitalized Patients

ObjectiveOwing to limited research, the effect of nonalcoholic fatty liver disease (NAFLD) on type 2 diabetes outcomes remains unclear. This study aimed to investigate the association between NAFLD and microvascular complications in hospitalized patients with type 2 diabetes.MethodsWe included 1982 patients with type 2 diabetes. NAFLD was defined as hepatic steatosis detected by ultrasound without secondary causes of fat accumulation. The diagnosis of diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy was based on clinical medical records. Risk for advanced liver fibrosis was categorized as “low risk,” “indeterminate risk,” and “high risk,” based on the NAFLD fibrosis score (NAFLD-FS). Logistic regression was used to test the association between NAFLD, risk for advanced fibrosis, and the presence of DR, DKD, and diabetic neuropathy.ResultsThe prevalence of NAFLD was 61.3%. The presence of DR and DKD was inversely associated with NAFLD, after adjusting for covariates. The presence of DR and DKD was higher in the “indeterminate risk” and “high risk” groups than in the “low risk” group, after adjusting for the same covariates. Only the presence of DKD significantly increased with high NAFLD-FS.ConclusionThe presence of DR and DKD was inversely associated with NAFLD among hospitalized patients with type 2 diabetes. DKD was closely associated with high NAFLD-FS among patients with NAFLD.     

Consensus Statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS) on Pediatric Benign and Malignant Thyroid Surgery

ObjectivesTo provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children.MethodsA literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.).ResultsTwenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus.ConclusionPediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.