Abstract:Vascular complications of type 1 diabetes mellitus (T1DM), clinically manifested as microvascular and macrovascular complications, are the most important causes of patients' death and disability. Poor glycemic control and elevated glycosylated hemoglobin (HbA1c) levels are the main risk factors for the development of vascular complications.Intensive hypoglycemic therapy can be used as a tertiary prevention method for T1DM patients to prevent vascular complications. Studies including new oral hypoglycemic agents and stem cell therapy for T1DM vascular complications have been started. It is expected to provide more methods and evidence-based medical evidence for the prevention and treatment of T1DM vascular complications. Deep understanding of the mechanism of occurrence and development of T1DM vascular complications is of great significance for the prevention and treatment of cardiovascular events in T1DM patients.

Abstract:Aim To observe the thickness variation of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in type 2 diabetes mellitus (T2DM) patients. To analyze the correlation of retinal neural structure parameters and microcirculation parameters. Methods This was a cross-sectional retrospective study including 45 T2DM patients (71 eyes) and 36 healthy controls (68 eyes). The optical coherence tomography angiography (OCTA) was used to examine GCC thickness, RNFL thickness, microvascular density of retinal superior capillary plexus, retinal deep capillary plexus and choroidal capillary plexus. Then the RNFL and GCC thickness changes were observed in the diabetic retinopathy (DR) patients of different stages, furthermore, the correlation was analyzed between these parameters and microvascular density. Results Compared with the control group, the focal loss volume (FLV, P＝0.00) and global loss volume (GLV, P＝0.00) of GCC thickness increased significantly in NDR group (DM patients without DR), so FLV and GLV might be the potential sensitive parameters to assess early loss of retinal ganglion cell (RGC) in NDR patients. Compared with the control group, the RNFL thickness decreased initially in the inferior and nasal quadrant in the patients with mild non-proliferative DR (NPDR) and moderate NPDR (P＝0.00), implying the more susceptibility regions for RNFL loss. In the severe NPDR group, the nasal RNFL thickness were still thinner (P＝0.00), whereas the inferior and temporal RNFL thickness went up significantly, compared with the control group (P＝0.00). In the PDR group, RNFL and GCC thickness in most regions were thicker than the control group, which might be relevant to retina thickening caused by the edema of retina. This might be supported by the positive correlation between the GCC/RNFL thickness and the retinal thickness revealed by the Spearman correlation analysis. In addition, the GCC and RNFL thickness were negatively correlated with retinal superficial capillary plexus(SCP) density, the deep capillary plexus (DCP) density and choroidal capillary plexus (CCP) density. Conclusion Local loss of GCC occurred in advance of the presence of DR, FLV and GLV in GCC thickness might be the potential sensitive parameters to assess early loss of RGC. With the development and progress of DR, the RNFL thickness tends to drop down influentially, then goes up finally. Therefore, further prospective and longitudinal clinical researches are needed.

Abstract:Aim To investigate the relationship between leptin and lower extremity atherosclerosis in patients with type 2 diabetes mellitus(T2DM). Methods Totally 71 male patients with T2DM were divided into 38 patients with lower extremity atherosclerosis and 33 patients without lower extremity atherosclerosis according to the results of lower limb artery color ultrasound. General information, biochemical indicators and serum leptin levels of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of lower extremity atherosclerosis in T2DM. Results Serum fasting blood glucose (7.97(6.7,9.37) mmol/L vs 6.97(6.7,8.04) mmol/L), glycated haemoglobin A1c (HbA1c)((8.15%±1.79%) vs (7.31%±1.22%)) and leptin levels ((227.60±58.08) ng/L vs (176.60±43.94) ng/L) were significantly higher in the group with lower extremity atherosclerosis than those in the group without lower extremity atherosclerosis (P＜0.05). High serum leptin level(OR=1.6,5%CI 1.002～1.030, P＝0.024) and HbA1c(OR=1.5,5%CI 1.060～2.874, P＝0.029) were the risk factors of lower extremity atherosclerosis in patients with T2DM. Conclusion The serum level of leptin is the risk factor of lower extremity atherosclerosis in patients with T2DM.

Abstract:Aim The purpose of this study was to investigate the relationship between carotid intima-media thickness (C-IMT) and glutamate decarboxylase antibody (GADA) titer in latent autoimmune diabetes in adults (LADA).Methods The data of 160 patients were selected from a randomized controlled clinical trial “Multi-center study of optimized LADA treatment based on protecting islet β-cell function” (NCT02407899) led by the National Clinical Research Center for Metabolic Diseases of the Second Xiangya Hospital of Central South University from September 2015 to April 2019. GADA titer was used as the cut-off value to divide LADA patients into LADA-1 (GADA≥0.3) with high titer and LADA-2 (0.05≤GADA<0.3) with low titer. C-IMT data and other clinical data were also collected for the cross-sectional study. Results Patients with type LADA-2 had significantly higher age, hypertension ratio, metabolic syndrome ratio, weight, body mass index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, fasting C-peptide, HOMA-IR and triglyceride levels(P＜0.05), but lower insulin usage ratio than patients with LADA-1(P＜0.01). Compared with patients with LADA-1, patients with LADA-2 had significantly higher percentage of thickened C-IMT (P＜0.01)and thicker C-IMT (P＜0.001). The difference is still significant after adjusting for related factors of metabolic syndrome. Multiple linear regression analysis showed that C-IMT was positively correlated with drinking history (P＜0.01) and negatively correlated with GADA titer (P＜0.01). The LADA patients were divided into low HOMA-IR (HOMA-IR≤2.0) and high HOMA-IR(HOMA-IR＞2.0) groups. LADA-1 patients with high HOMA-IR had significantly increased C-IMT than those with low HOMA-IR. (P＜0.01), but there was no difference between LADA-2 patients with low and high HOMA-IR. Conclusion LADA patients with low GADA titer have a higher risk of atherosclerosis than LADA patients with higher GADA titer, and the risk is associated with insulin resistance. GADA titer is an independent factor of C-IMT in LADA patients.

Abstract:Aim To investigate the clinical characteristics of type 2 diabetic patients with a course of less than one year and the influencing factors of carotid intima-media thickness(C-IMT), so as to provide scientific basis for early screening and prevention of macrovascular complications in patients with type 2 diabetes(T2DM). Methods 64 patients with T2DM with the course less than one year in the outpatient department of metabolism and endocrinology were recruited. Anthropometric parameters, blood pressure, blood glucose, islet function, lipid profile, liver and kidney function were collected. In addition, bilateral C-IMT was detected by color doppler ultrasound and body fat was detected by dual-energy X bone densimeter. According to the results of carotid ultrasound, the patients were divided into non-subclinical atherosclerosis group(16 cases) and subclinical atherosclerosis group(48 cases). The clinical characteristics of the two groups were compared and the influencing factors of atherosclerosis were analyzed by binary Logistic regression.Results The proportion of 64 patients with subclinical was 75.0%. Compared with the non-subclinical atherosclerosis group, the subclinical atherosclerosis group had older age, a higher proportion of history of hypertension, a higher body mass index, higher blood cholesterol, higher LDL, and a higher proportion of metabolic syndrome(P＜0.05). The correlation analysis showed that age was positively correlated with the thickness of the medial membrane(r＝0.32, P＜0.05). Binary Logistic regression analysis showed that age(OR=1.10) and male(OR=9.24) were risk factors for subclinical atherosclerosis(P＜0.05). Conclusion Subclinical atherosclerosis accounts for a high proportion of patients even though the duration is not long. Type 2 diabetic patient with elderly, male or metabolic syndrome are more likely to develop atherosclerosis, so it is more important for them to screen for macrovascular lesions as early as possible.

Abstract:The prevalence of diabetes is increasing globally. Diabetic vascular complications are the primary cause of death and disability in the elderly at present. Fatty acid binding protein (FABP), a family of lipid chaperones, is a key inflammatory molecule linking obesity, diabetes and vascular diseases, and plays an important role in diabetic vasculopathy. This article reviews the molecular mechanism of FABP family members in the occurrence and development of diabetes mellitus and its vasculopathy, the therapeutic value as intervention target and the clinical significance as biomarkers, in order to provide evidence and ideas for the research and development of anti-diabetic vasculopathy drugs represented by FABP.

Abstract:The incidence rate of diabetes has increased dramatically in recent years, becoming another major disease next to cardiovascular and cerebrovascular diseases and cancer, and seriously endangering human health. Diabetic heart disease is the most serious in diabetes, with extremely high mortality. Diabetes affects the heart in three ways:coronary artery disease, diabetic cardiomyopathy, and cardiac autonomic neuropathy. Different types of diabetes have different incidence. The pathogenesis of the three types of diabetic heart disease has something in common, but the means of screening and treatment are different. This review integrates the latest developments related to the mechanism, clinical screening and potential therapeutic approaches of diabetic heart disease.

Abstract:Diabetes is a group of metabolic diseases characterized by disorders of glucose metabolism, which are caused by a variety of environmental and genetic causes. Diabetic nephropathy (DN) is the most common and severe chronic comorbidity in patients with diabetes. At present, diabetic nephropathy accounts for about 40% of diabetic patients, and is the main cause of chronic kidney disease (CKD) worldwide. At present, China is already the world's largest country with diabetes and a country with diabetic nephropathy. This article reviews the new research progress in the diagnosis and treatment of diabetic nephropathy. Designed to provide the latest information on DN diagnosis and treatment.

Abstract:Aim To investigate the changes of the positive rate of full-length membrane-enchored T cell immunoglobulin and mucin-domain containing molecule family-3 (flTim-3) on CD14＋ monocyte in peripheral blood and the levels of serum soluble Tim-3 (sTim-3), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in patients with coronary heart disease (CHD) and their clinical significance. Methods 196 suspected CHD patients were selected as the study subjects, and all the selected patients underwent coronary angiography. According to the results of coronary angiography and CHD diagnostic criteria, the selected patients were divided into non-CHD group (n＝54), stable angina pectoris (SAP) group (n＝87) and acute coronary syndrome (ACS) group (n＝55). General information was recorded. The positive rate of flTim-3 in peripheral blood monocytes was determined by flow cytometry. The concentrations of serum sTim-3, TNF-α and IL-6 were measured by enzyme-linked immunosorbent assay. Results Compared with non-CHD group, flTim-3 positive rate, TNF-α, IL-6 concentrations in SAP group and ACS group were higher, and ACS group was higher more, the difference was statistically significant (P＜0.05); While sTim-3 concentration was lower, ACS group was lower more, the difference was statistically significant (P＜0.05). Pearson correlation analysis showed that flTim-3 was positively correlated with TNF-α and IL-6, while sTim-3 was negatively correlated with TNF-α and IL-6 (P＜0.01). Logistic regression analysis showed that flTim-3, sTim-3, TNF-α, IL-6 were correlated with the clinical phenotype of CHD (P＜0.05). Conclusion FlTim-3 and sTim-3 affect the clinical phenotype of CHD by regulating the expression of monocyte/macrophage inflammatory factors. FlTim-3 and sTim-3 have predictive value for the clinical phenotype of CHD.

Abstract:Aim To investigate the effects of Qiliqiangxin capsule on oxidative stress and expressions of miRNA-21 (miR-21) and miRNA-145 (miR-145) in peripheral blood of patients with coronary heart disease and heart failure.Methods The 86 patients with coronary heart disease and heart failure admitted to our hospital from January 2017 to December 2018 were selected as the study subjects. They were randomly divided into control group (43 cases) and observation group (43 cases) by random number table method. The patients in the control group were treated with routine therapy, while the patients in the observation group were treated with Qiliqiangxin capsule on the basis of the control group. Both groups were treated for 4 weeks. The therapeutic effect, cardiac function, BNP, oxidative stress indexes and the expressions of miR-21 and miR-145 in peripheral blood before and after treatment were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group (93.02% vs 72.09%, P＜0.05). After treatment, the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the observation group were lower than those in the control group, while the left ventricular ejection fraction was higher than that in the control group (P＜0.05). The level of BNP in the two groups after treatment was lower than that before treatment (P＜0.05); After treatment, the level of BNP in the observation group was significantly lower than that in the control group (P＜0.05). The level of malondialdehyde (MDA) in the two groups after treatment was lower than that before treatment, while the level of superoxide dismutase (SOD) was higher than that before treatment (P＜0.05); After treatment, the MDA level of the observation group was lower than that of the control group, while the SOD level was higher than that of the control group (P＜0.05). The expressions of miR-21 and miR-145 in peripheral blood of the two groups after treatment was lower than that before treatment (P＜0.05); After treatment, the expressions of miR-21 and miR-145 in the peripheral blood of the observation group was lower than that of the control group (P＜0.05). After 3-10 months follow-up, the rates of readmission and mortality in the observation group were lower, and its readmission rate was significantly lower than that in the control group (P＜0.05). Conclusion Qiliqiangxin capsule has a good therapeutic effect on patients with coronary heart disease and heart failure, and it can reduce the level of plasma BNP, oxidative stress injury and the expressions of miR-21 and miR-145 in peripheral blood.

Abstract:Aim To observe the relationship between serum lipoprotein(a) [Lp(a)], β2-microglobulin (β2-MG) and tumor necrosis factor-α (TNF-α) levels and degree of coronary artery lesion in patients with acute coronary syndrome (ACS), and to analyze their clinical significance. Methods A total of 87 patients diagnosed as ACS from June 2015 to June 2018 was collected, including 54 cases of unstable angina pectoris (UA) and 33 cases of acute myocardial infarction (AMI). Another 32 healthy person with basically matched age and gender in the same period were selected as control group. The levels of serum Lp(a), β2-MG and TNF-α were detected in all subjects, and the relationship between their levels and degree of coronary artery lesion was analyzed. Results Compared with control group, serum levels of Lp(a), β2-MG and TNF-α in ACS patients were increased significantly (P＜0.05), and serum levels of Lp(a) and TNF-α in AMI group were significantly higher than those in UA group (P＜0.05). With the increase of coronary artery lesion number and modified Gensini score grading, the serum levels of Lp(a), β2-MG and TNF-α in ACS patients were also increased (P＜0.05). Pearson correlation analysis showed that serum Lp(a), β2-MG and TNF-α levels were positively correlated with the number of coronary lesions and the modified Gensini score grading in ACS patients, respectively (P＜0.05). Logistic regression analysis showed that serum Lp(a), β2-MG and TNF-α levels were independent risk factors for ACS, in addition to the conventional influencing factors of ACS. Conclusions Serum levels of Lp(a), β2-MG and TNF-α in ACS patients are positively correlated with the degree of coronary artery lesions. With the disease aggravation of ACS patients, serum levels of Lp(a), β2-MG and TNF-α also rise.

Abstract:Aim To investigate the expression and correlation of nuclear factor κB (NF-κB), Toll-like receptors (TLR) and inflammatory cytokines in the rupture of intracranial aneurysm (IA). Methods The IA and IA ruptured aneurysm tissues were collected by surgery as the IA group and the IA rupture group, and healthy vascular tissues were collected as a control group. The levels of NF-κB, TLR4, interleukin 1β (IL-1β) and hypersensitive C-reactive protein (hs-CRP) mRNA in aneurysm tissues were detected by qPCR. NF-κB and TLR4 protein levels were detected by Western blot. The levels of IL-1β and hs-CRP in the serum of each group were detected by enzyme-linked immunosorbent assay.Results The levels of NF-κB, TLR4, IL-1β and hs-CRP mRNA and protein in the aneurysm of IA group and IA rupture group were significantly higher than those of the control group (P＜0.05). The levels of NF-κB, TLR4, IL-1β and hs-CRP mRNA and protein in the aneurysm of IA rupture group were significantly higher than those of IA group (P＜0.05). Serum IL-1β and hs-CRP were significantly higher in the IA group and the IA rupture group than in the control group (P＜0.05). The levels of serum IL-1β and hs-CRP in the IA rupture group were significantly higher than those in the IA group (P＜0.05). Conclusion Compared with IA patients, IA-ruptured patients have higher levels of NF-κB, TLR4, IL-1β, and hs-CRP mRNA and protein expression in aneurysms, suggesting that NF-κB, TLR4, IL-1β, and hs-CRP are involved in IA rupture.

Abstract:Aim To investigate the expression of serum interleukin-16 (IL-16) and copeptin in patients with acute myocardial infarction (AMI) and its clinical significance. Methods 108 patients with AMI were enrolled. The patients were divided into acute ST-segment elevation myocardial infarction (STEMI) group (55 cases) and acute non-ST-segment elevation myocardial infarction (NSTEMI) group (53 cases) according to the ECG results. Another 50 healthy volunteers who underwent physical examination were selected as the control group. Serum IL-16,copeptin, tumor necrosis factor alpha (TNF-α), IL-18, high sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI) were detected in three groups.Results The levels of serum IL-16, copeptin, TNF-α, IL-18, hs-CRP, NT-proBNP, CK-MB and cTnI in the STEMI group were higher than those in the NSTEMI group and the control group, and the differences were statistically significant (P＜0.05). The levels of serum IL-16, copeptin, TNF-α, IL-18, hs-CRP, NT-proBNP, CK-MB and cTnI in the NSTEMI group were higher than those in the control group, the differences were statistically significant (P＜0.05). Logistic regression analysis showed that serum IL-16 had a close relationship with TNF-α, hs-CRP, NT-proBNP, CK-MB and cTnI in AMI patients (P＜0.05). Serum copeptin had a close relationship with hs-CRP, NT-proBNP, CK-MB and cTnI in patients with AMI (P＜0.05). Conclusions The levels of serum IL-16 and copeptin in patients with AMI are significantly increased, and they are closely related to the expression of some inflammatory factors and myocardial markers. It is easy to obtain serum samples, and the detection method is simple. Clinical information can be obtained by detecting the levels of IL-16 and copeptin in serum of patients with AMI.

Abstract:Renal aging is a main cause of the increase in the incidence rate of acute kidney injury and chronic kidney disease. Even in the absence of age-related comorbidities such as hypertension, the structure and function of kidney in the healthy elderly groups may degenerate, leading to increased kidney susceptibility to injury, insufficient repair capacity and pathological changes. Renal aging is a multifactorial regulatory process, clarifying the mechanisms behind may help repair the damage caused by acute kidney injury and chronic kidney disease. Published papers are reviewed in this article to demonstrate the process of kidney aging from aspects of cellular structural function changes and molecular mechanisms, so that more effective treatments can be found.

Abstract:Coronary artery endothelial injury is the initiating and the most critical factor of atherogenesis. For a long time, researchers have focused on the mechanism of endothelial injury induced by oxidized low density lipoprotein(ox-LDL). With the development of new technologies and methods, the role of micro-RNA (miRNA) in the process of endothelial cell injury induced by ox-LDL has been gradually discovered. This review briefly describes the miRNAs involved in endothelial injury such as endothelial inflammation, autophagy, apoptosis and dysfunction under the condition of hyperlipidemia. Summarizing these miRNAs may permit new ideas for the prediction, diagnosis and even treatment of coronary atherosclerosis.

Abstract:With the development of coronary angiography technology, coronary microvascular disease (CMVD) has attracted more and more attention. In recent years, it has been found that most patients with CMVD have poor prognosis, so the detection of CMVD is particularly important. Any cause of CMVD will lead to a decrease in coronary flow reserve (CFR), so the measurement of CFR can be used as an important examination method to diagnose CMVD. This paper will review the research progress of CFR and CMVD.

Abstract:Lipoxins (LX), metabolites of arachidonic acid, are one of the most important endogenous lipid mediators which initiate inhibition in ammatory reaction as well as promote extinction of in ammation resolution. Nowadays, the role of LX in diabetes, obesity, cardiovascular disease and other metabolic diseases has attracted wide attention. Therefore, this paper reviews the biological function of LX and its research progress in metabolic diseases.