Qiong Wei

Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence.

A retrospective case-control study of 118 (male : female, 68 : 50) Chinese type 2 diabetic patients with foot ulcers (Wagners grade 3-5) was conducted to determine the prevalence and risk factors for meticillin-resistant Staphylococcus aureus (MRSA) infection in relation to the original community or hospital parameters. Ulcer specimens were processed for Gram staining, aerobic culture and antimicrobial susceptibility testing. Staphylococcus species were tested for meticillin resistance using oxacillin. S. aureus was the most frequent pathogen (25.6 %) in diabetic patient specimens (160 isolates), and a high proportion of S. aureus isolates were MRSA (63.4 %). A high percentage of S. aureus isolates (65.4 %) satisfied the definition for hospital-associated MRSA (HA-MRSA) infection. The size of ulcers [adjusted odds ratio (OR) 1.61; 95 % confidence interval (CI) 1.22-2.12] and osteomyelitis (adjusted OR 18.51, 95 % CI 2.50-137.21) were independent predictors of MRSA infection. The HA-MRSA group had a significantly different distribution from the community-associated MRSA group with respect to age, history of diabetes and length of hospital stay (all P<0.001). Neuropathy, vascular disease (all P=0.049) and osteomyelitis (P=0.026) were the most common underlying conditions observed in the HA-MRSA group. This study contributes to the establishment of precautions against the emergence of MRSA including MRSA acquired from different sources among the Chinese population with diabetic foot ulcers based on their original or clinical parameters.

Statin therapy on glycaemic control in type 2 diabetes: a meta-analysis

Objective: Randomised controlled trials (RCTs) indicate that statin therapy has cardiovascular benefit among patients with type 2 diabetes. Recently, statins were reported to increase risk of diabetes by 9%. The aim was to investigate by a meta-analysis whether statins deteriorate glycaemic control in type 2 diabetes. Methods: Medline, EMBASE and Cochrane Central Register of Controlled Trials from 1966 to 2012 were searched for RCTs of statins. Included were only trials with type 2 diabetes. Main outcome measures: The I2 statistic was used to measure heterogeneity between trials and calculated mean differences for glycaemic parameters with random-effect meta-analysis. Results: 26 eligible studies were identified with 3232 participants. Statin therapy had no remarkable influence on HbA1c (WMD 0.04%, 95% CI -0.08 to 0.16, I² = 45.7%, n = 3070), FPG (2.25 mg/dl, 95% CI -3.50 to 7.99, I² = 46%, n = 1176), BMI, fasting insulin or HOMA-IR. However, subgroup analysis showed significant, detrimental effect of atorvastatin on HbA1c, whereas simvastatin presented an ameliorative effect. Meta-regression presented that neither baseline age nor relative reduction in LDL-cholesterol concentrations accounted for residual heterogeneity. Conclusion: Statin therapy showed non-significant effect on glycaemic control in type 2 diabetes. Statin therapy need not change among them with moderate or high cardiovascular risk or existing cardiovascular disease.

Effect of a CGMS and SMBG on Maternal and Neonatal Outcomes in Gestational Diabetes Mellitus: a Randomized Controlled Trial

In this study, we sought to investigate the effects of a continuous glucose monitoring system (CGMS) on maternal and neonatal outcomes. A total of 106 women with gestational diabetes mellitus (GDM) in gestational weeks 24–28 were randomly allocated to the antenatal care plus CGMS group or the self-monitoring blood glucose (SMBG) group. The CGMS group was subdivided into early and late subgroups. There were no significant differences in prenatal or obstetric outcomes, e.g., caesarean delivery rate, Apgar score at 5 min, macrosomia or neonatal hypoglycaemia, between the CGMS and SMBG groups. The CGMS group had lower glycated haemoglobin (HbA1C) levels than the SMBG group; however, the difference was not statistically significant. The proportion of GDM women with excessive gestational weight gain was lower in the CGMS group than in the SMBG group (33.3% vs. 56.4%, P = 0.039), and women who initiated CGMS earlier gained less weight (P = 0.017). The mode of blood glucose monitoring (adjusted OR 2.40; 95% CI 1.030–5.588; P = 0.042) and pre-pregnancy BMI (adjusted OR 0.578; 95% CI 0.419–0.798; P = 0.001) were independent factors for weight gain. In conclusion, early CGMS for GDM mothers reduces gestational weight gain. A follow-up study with a large cohort is needed.

The effects of astrocytes on differentiation of neural stem cells are influenced by knock-down of the glutamate transporter, GLT-1

The majority of glutamate released during neurotransmission is uptaken into astrocytes through the glial glutamate transporter GLT-1, by which extracellular glutamate is inactivated. In this study, we determined whether GLT-1 mediated the astrocyte regulation of the cell fate of neural stem/progenitor cells (NSCs) by glutamate reuptake. The astrocytes stimulated neuronal lineage selection but inhibited glial lineage cells. However, all these effects were reversed after siRNA-targeting GLT-1 was delivered into astrocytes by lentiviral vectors. NSC and astrocyte co-culture also increased the synaptophysin protein levels of NSC-derived new neurons through GLT-1. Glutamate was found to be present in the supernatants of the co-culture and astrocytes under different medium conditions, which may be attributed to the slower rate of clearance of the released glutamate. Dysfunctional glutamate reuptake may be the major consequence of GLT-1 functional silence in astrocytes. These results indicated that astrocytes regulated NSCs in reactive astrogliosis, neuronal generation, and synaptic function through GLT-1.

Higher pre-pregnancy body mass index is associated with excessive gestational weight gain in normal weight Chinese mothers with gestational diabetes.

To assess how pre‐pregnancy body mass index (BMI) affects pregnancy outcome and total gestational weight gain (GWG) in a cohort of women with gestational diabetes (GDM).

PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM IN OLDER PATIENTS WITH DIABETES MELLITUS WITH POORLY CONTROLLED DYSLIPIDEMIA IN CHINA

To the Editor: Atherosclerotic complications are the leading cause of death in patients with diabetes mellitus. Poor control of dyslipidemia is often observed in these patients and is considered to be a cardiovascular risk factor. It was recently found that the prevalence of uncontrolled dyslipidemia is high in Chinese patients with diabetes mellitus, particularly in women. Subclinical hypothyroidism (SCH) is a state in which patients have mildly high serum thyroidstimulating hormone (TSH) concentrations with normal serum levels of free thyroxine and triiodothyroxine. Despite conflicting results, SCH is thought to increase the risk for atherosclerosis because of its association with dyslipidemia. Controversy still persists as to whether screening and treatment of SCH is warranted because of a lack of persuasive evidence, and the prevalence of SCH in older patients with diabetes mellitus and poorly controlled dyslipidemia in China is unknown. This cross-sectional study included data collected for 532 Chinese inpatients aged 60 and older with type 2 diabetes mellitus and poorly controlled dyslipidemia. They had no history of previous lipid-lowering therapy. Dyslipidemia was defined as low-density lipoprotein cholesterol (LDL-C) of 2.6 mmol/L (100 mg/dL) or greater, high-density lipoprotein cholesterol (HDL-C) of 1.0 mmol/L (40 mg/ dL) or less in men and 1.3 mmol/L (50 mg/dL) or less in women, triglycerides (TG) of 1.5 mmol/L or greater, or total cholesterol (TC) of 4.5 mmol/L or greater. The prevalence of SCH was calculated for each sex and for the lipoprotein levels mentioned above. Male and female patients with diabetes mellitus and well-controlled dyslipidemia had similar ages, frequency of tobacco consumption, hypertension, diabetes control status, glycosylated hemoglobin, and body mass indexes. In terms of lipoprotein profiles, men and women with poorly controlled dyslipidemia had higher TG, TC, and LDL-C levels and lower HDL-C levels than their counterparts (all Po.001). The apolipoprotein (apo) A1 level was similar between those with well-controlled and poorly controlled dyslipidemia in men and women, although the ratio of apo B to apo A1 was higher in men and women with poorly controlled dyslipidemia. The proportion of patients with SCH was higher in patients with LDL-C of 2.6 mmol/L or greater than in those with LDL-C less than 2.6 mmol/L (P 5.02). Similarly, the prevalence of SCH was significantly higher in men with HDL-C of 1.0 mmol/L or less and in women with HDL-C of 1.3 mmol/L or less (P 5.047). There was no significant difference in the prevalence of SCH according to control of TG and TC (P 5.42, P 5.70; Figure 1). A total of 17.5% of the women with diabetes mellitus and poorly controlled dyslipidemia were diagnosed with SCH, which was significantly higher than in those with well-controlled dyslipidemia (7.1%, P 5.01). No significant difference was observed in male patients (3.8% vs 3.2%, P 5.81). The proportion of female patients with LDL-C of 2.6 mmol/L or greater with SCH was greater than that for female patients with LDL-C less than 2.6 mmol/L (22.7% vs 7.7%, P 5.02), whereas there was no difference in male patients (P 5.15). Furthermore, for male or female patients with uncontrolled dyslipidemia, there was no difference in the prevalence of SCH between patients with HDL-C greater than 1.0 mmol/L for men or greater than 1.3 mmol/ L for women and those with HDL-C of 1.0 mmol/L or less for men (P 5.78) or 1.3 mmol/L or less for women (P 5.63). Similarly, there was no difference in the prevalence of SCH between patients with TG of 1.5 mmol/L or greater and those with TG less than 1.5 mmol/L (P 5.54 for men, P 5.98 for women) or between patients with TC of 4.5 mmol/L or greater and those with TC less than 4.5 mmol/L (P 5.22 for men and P 5.52 for women). The number of subjects was too small to stratify the TSH levels in patients with SCH, particularly men, to study the association between dyslipidemia and the level of TSH. It was appropriate for the data to be analyzed by comparing the lipid status of those with supposed SCH with that of those without SCH. For the female patients with diabetes mellitus and SCH, the prevalence of poorly controlled LDL-C ( 2.6 vs o2.6 mmol/L, 62.9% vs 31.4%), HDL-C ( 1.3 vs 41.3 mmol/L, 60.0% vs 36.3%), or TC ( 4.5 vs o4.5 mmol/L, 51.4% vs 29.4%) was higher than in those without SCH (all Po.05). This finding suggests an association between dyslipidemia and SCH in female patients with diabetes mellitus. These data indicate that SCH is more common in older female patients with diabetes mellitus (aged 60) with poorly controlled dyslipidemia. These findings are also consistent with recent American guidelines, which recommend LDL-C HDL-C TG TC Diabetes mellitus without dyslipidemia

Optimal target range for blood glucose in hyperglycaemic patients in a neurocritical care unit

Background: Hyperglycaemia is common among patients with critical neurological injury, even if they have no history of diabetes. The optimal target range for normalizing their blood glucose is unknown. Methods: Retrospective data were extracted from 890 hyperglycaemic individuals (glucose > 200 mg/dL) admitted to neuroscience critical care unit (NCCU) and these patients were divided into two groups: intensive glucose control group with target glucose of < 140 mg/dL achieved and moderate control with glucose levels 140-180 mg/dL. The groups were also stratified according to the hyperglycaemia type (pre-existing diabetes or stress-related). We defined the primary endpoint as death from any cause during NCCU admission. Results: In NCCU, tighter control of blood glucose at ≤ 140 mg/dL was associated with increased, mortality of individuals with pre-existing diabetes compared with moderate control [29 of 310 patients (9.4%) vs 15 of 304 patients (4.9%), p = 0.034]. Patient age [adjusted odds ratio (OR) = 1.12; 95% confidence interval (CI) = 1.05–1.19; p < 0.001], level of glycated haemoglobin (adjusted OR = 1.24; 95% CI = 1.04–1.48; p = 0.017) and hypoglycaemia (adjusted OR = 10.3; 95% CI = 2.92–36.6; p < 0.001) were positively associated with higher mortality. Death rate was lower among stress-related hyperglycaemic patients with tighter glucose controlled at ≤ 140 mg/dL [6 of 140 patients (4.3%) vs 15 of 136 patients (11.0%), p = 0.035]. Conclusion: A differential association is evident between glucose levels and mortality in diabetes and stress-related hyperglycaemia patients. However, given the observational nature of our work, no clinical recommendations can be given and prospective studies are required to further investigate these findings.

The effect of pre-pregnancy body mass index and excessive gestational weight gain on the risk of gestational diabetes in advanced maternal age

BACKGROUND AND PURPOSE With the popularization of a two-child policy in China, the number of pregnant women of advanced maternal age will increase steadily. We aimed to assess the association between pre-pregnancy body mass index (BMI) and weight gain in the first and second trimester and the risk of gestational diabetes (GDM) in the advanced maternal age group and control group defined as maternal age of 20-35 years. RESULTS The risk of GDM for obesity before pregnancy was 2.707 (95% CI: 1.042-7.029) folds and 3.612 (95% CI: 1.182-11.039) folds in the control group and advanced maternal age group, respectively. Excessive weight gain in the first trimester was significant related to a higher risk of developing GDM with the odds ratio (OR) of 2.655 (95% CI: 1.265-5.571) and 4.170 (95% CI: 1.437-12.100) in the control group and advanced maternal age group, respectively. MATERIALS AND METHODS This prospective cohort study included 565 pregnant women with singleton pregnancy who were recruited in their first prenatal visit from the antenatal clinic in March and December 2016. Maternal weight was recorded before pregnancy, in the first prenatal visit and at the time of screening oral glucose tolerance test (OGTT). All women underwent 2 h 75g-OGTT at 24-28 weeks (24 weeks on average). GDM was diagnosed according to the standards issued by the Ministry of Health of China in 2011. CONCLUSIONS Elevated pre-pregnancy BMI independently increases the risk of GDM, particularly in advanced maternal age. Excessive weight gain in the first trimester is significantly associated with the incidence of GDM regardless of pre-pregnancy BMI.Background and purpose With the popularization of a two-child policy in China, the number of pregnant women of advanced maternal age will increase steadily. We aimed to assess the association between pre-pregnancy body mass index (BMI) and weight gain in the first and second trimester and the risk of gestational diabetes (GDM) in the advanced maternal age group and control group defined as maternal age of 20–35 years. Results The risk of GDM for obesity before pregnancy was 2.707 (95% CI: 1.042–7.029) folds and 3.612 (95% CI: 1.182–11.039) folds in the control group and advanced maternal age group, respectively. Excessive weight gain in the first trimester was significant related to a higher risk of developing GDM with the odds ratio (OR) of 2.655 (95% CI: 1.265–5.571) and 4.170 (95% CI: 1.437–12.100) in the control group and advanced maternal age group, respectively. Materials and methods This prospective cohort study included 565 pregnant women with singleton pregnancy who were recruited in their first prenatal visit from the antenatal clinic in March and December 2016. Maternal weight was recorded before pregnancy, in the first prenatal visit and at the time of screening oral glucose tolerance test (OGTT). All women underwent 2 h 75g-OGTT at 24–28 weeks (24 weeks on average). GDM was diagnosed according to the standards issued by the Ministry of Health of China in 2011. Conclusions Elevated pre-pregnancy BMI independently increases the risk of GDM, particularly in advanced maternal age. Excessive weight gain in the first trimester is significantly associated with the incidence of GDM regardless of pre-pregnancy BMI.

Crosstalk between monocytes and renal mesangial cells via interaction of metalloproteinases and fractalkine in diabetic nephropathy

An increasing number of studies suggest that the activation of innate immunity with the development of a chronic low‑grade inflammatory response is a factor in the pathogenesis of diabetic nephropathy (DN). Advanced glycation end products (AGEs), chemokines and matrix metalloproteinases (MMPs) are known to be important in inflammatory reactions in DN. In the present study, the inter-regulation of MMP2 and fractalkine was observed between monocytes (U937) and human renal mesangial cells (HRMCs) and its potential pathophysiological role in DN. The expression of fractalkine and MMP2 was analyzed by RT-PCR, western blot analysis and enzyme‑linked immunosorbent assay. The chemotaxis and adhesiveness of HRMCs to U937 cells was detected with a transwell system, co‑culture and fluorescent staining, respectively. The results showed a decreased expression of MMP2 and an increased expression of fractalkine by AGEs in HRMCs. Fractalkine downregulated the mRNA expression and activity of MMP2, and the reduced MMP2 activity was reversed with an anti‑fractalkine antibody. Conversely, MMP2 upregulated fractalkine mRNA and protein expression in HRMCs, which led to an increase in chemotaxis and a decrease in monocytic adhesion to HRMCs. In conclusion, these observations suggest a crosstalk between monocytes and HRMCs via the interaction of MMP2 and fractalkine, which may represent a therapeutic target to impede the inflammatory process associated with DN.