To investigate the predictive value of HGI for HUA in T2DM.

Eligible participants were T2DM patients (n=1 194) who received treatment and personal health record creation services from Department of Endocrinology, the Affiliated Hospital of Southwest Medical University between January 2017 and January 2021. Demographics, physical examination information, laboratory test markers and calculated HGI were collected. HUA prevalence was compared across tertile groups of HGI〔low HGI (<-0.94%), moderate HGI (-0.94%≤HGI<0.27%), and high HGI (HGI≥0.27%) 〕. Multivariate Logistic regression analysis was used to explore the factors affecting the development of HUA in T2DM. The receiver operating characteristic (ROC) curve was plotted for HGI with clinical markers in predicting HUA in T2DM.

Low HGI group had much lower prevalence of HUA than did moderate HGI group 〔17.09% (68/398) vs 27.14% (108/398), χ²=11.672, P<0.01〕 and high HGI group 〔17.09% (68/398) vs 31.66% (126/398), χ²=22.928, P<0.01〕. Multivariate Logistic regression analysis found that age〔OR=1.048, 95%CI (1.029, 1.067) 〕, subcutaneous fat area (SFA) 〔OR=1.006, 95%CI (1.001, 1.010) 〕, triglyceride (TG) 〔OR=1.096, 95%CI (1.034, 1.161) 〕, high density lipid-cholesterol (HDL-C) 〔OR=0.560, 95%CI (0.326, 0.961) 〕, and HGI 〔OR=1.360, 95%CI (1.208, 1.531) 〕 independently influenced the development of HUA in T2DM (P<0.05). After adjusting for age, SFA, TG, and HDL-C, it was found that the risk of HUA was 1.855 times higher in moderate HGI group 〔95%CI (1.283, 2.681), P<0.001〕, and 2.192 times higher in high HGI group 〔95%CI (1.530, 3.141), P<0.001〕 compared to that of low HGI group. The AUC for HGI with clinical markers〔Logit (P) =-4.549+0.618×moderate HGI+0.785×high HGI+0.039×age+0.008×SFA+0.088×TG-0.750×HDL-C〕 to diagnose HUA in T2DM was 0.71〔95%CI (0.68, 0.75) 〕, with sensitivity of 78.7%, specificity of 53.5%, Youden index of 0.322, and optimal cut-off value of 0.208.

T2DM patients with elevated HGI may be more prone to HUA. HGI could be used as a clinical predictor of HUA in T2DM.

To screen the risk factors of DPN in type 2 diabetes, and used them to develop a predictive nomogram as a visualization tool assisting clinical diagnosis of this disease.

Participants (n=15 020) were type 2 diabetics who were retrospectively selected from the First Affiliated Hospital of Xinjiang Medical University from 2010 to 2019, and 75% of them were randomly assigned to a training group (n=11 265) and other 25% to a verification group (n=3 755). Patients' basic personal information and biochemical data were collected. Independent predictors of DPN were screened by Lasso regression analysis, and further analyzed using multivariate Logistic regression analysis, then the finally determined ones were used to develop a predictive nomogram. The performance of the nomogram was verified in the verification group. Finally, the area under the ROC curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the identification ability, accuracy and clinical applicability of the nomogram.

Among the 15 020 cases, 6 133 had DPN, and other 8 887 did not. The findings of Lasso regression with multivariate Logistic regression analyses showed that age〔OR=1.034, 95%CI (1.031, 1.039) 〕, diabetic retinopathy〔OR=11.881, 95%CI (10.756, 13.135) 〕, duration of diabetes〔OR=1.070, 95%CI (1.061, 1.078) 〕, glycosylated hemoglobin〔OR=1.237, 95%CI (1.209, 1.266) 〕 and high-density lipoprotein〔OR=0.894, 95%CI (0.877, 0.901) 〕were associated with DPN. The predictive nomogram was established by employing the above-mentioned variables. The AUC of the nomogram for identifying DPN in the training group was 0.858〔95%CI (0.851, 0.865) 〕, and in the validation group was 0.852〔95%CI (0.840, 0.865) 〕. The nomogram was found with a high goodness of fit by the Hosmer-Lemeshow test (P>0.05). DCA showed that when the threshold probability of patients was 0 to 0.9, using the nomogram resulted in higher net benefit of predicting the risk of DPN.

We successfully established and verified a nomogram (with above-mentioned five variables included) with a high accuracy, which may be used as a tool facilitating the improvement in early identification or screening of DPN in high-risk type 2 diabetics.

To explore the risk factors of dysphagiain PD.

One hundred and seven consecutive PD patients were recruited in Henan Provincial People's Hospital from June 2018 to December 2019, and general demographic data, incidence of dysphagia and sialorrhea, disease stage and illness severity, severity of anxiety and depression, cognitive function, as well as uric acid and homocsteine were retrospectively analyzed. Risk factors of dysphagia in PD were explored using multivariate Logistic regression analysis. ROC curve analysis was used for evaluating the predictive value of independent risk factors for dysphagia in PD.

Of the 107 PD patients, 45 with dysphagia and 62 without were assigned to an observation group and a control group, respectively, with an incidence of dysphagia of 42.1% (45/107). There were significant difference in terms of age, Hoehn-Yahr classification, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅰ, Ⅱ and Ⅲ scores, incidence of sialorrhea, the 14-item Hamilton Anxiety Scale (HAMA-14) score, the 24-item Hamilton Depression Scale (HAMD-24) score, Mini-mental State Examination (MMSE) score and uric acid between these two groups (P≤0.05). Multivariate Logistic regression analysis showed that, UPDRSⅢ score≥35〔OR=7.639, 95%CI (2.750, 21.219) 〕, sialorrhea〔OR=3.336, 95%CI (1.178, 9.447) 〕, HAMA-14 score≥13〔OR=2.847, 95%CI (1.027, 7.894) 〕and uric acid <251 μmol/L〔OR=0.354, 95%CI (0.129, 0.971) 〕were independent risk factors of dysphagia in PD (P<0.05). ROC curve analysis showed that, AUC of UPDRS Ⅲ score, sialorrhea, HAMA-14 score and uric acid was 0.750, 0.682, 0.638 and 0.670 in predicting dysphagia in PD, with sensitivity of 69.4%, 56.5%, 59.7% and 64.5%, specificity of 80.0%, 80.0%, 71.1% and 66.7%, Youden index of 0.494, 0.365, 0.308 and 0.312, respectively.

UPDRSⅢ score≥35, HAMA-14 score≥13, sialorrhea and uric acid <251 μmol/L are independent risk factors of dysphagia in PD, and the above four risk factors has certain predictive value for dysphagia in PD.

To explore the relationship of visceral fat with BMD and osteoporotic fracture risk in T2DM patients.

Participants were selected during July to December 2019, including 202 T2DM inpatients from Endocrine Department, Yiyang Central Hospital, and 202 non-diabetics from three towns (Mahekou, Nanzhou, and Maocaojie) and one township (Wuzui) of Nan County, Yiyang, using multistage stratified random sampling. All the assessment examinations were conducted in Yiyang Central Hospital, specifically, BMD at lumbar spine, femoral neck and total hip was measured by dual-energy X-ray absorptiometry, subcutaneous and visceral fat areas were measured by DUALSCAN HDS-2000 visceral fat analyzer (Omron, Japan), and 10-year major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) or 10-year hip osteoporotic fracture risk was assessed by FRAX questionnaire. T2DM inpatients who completed a FRAX questionnaire in which the item of rheumatoid arthritis was substituted by diabetes, namely, diabetes was considered as a risk factor for osteoporotic fractures, whose assessment results were expressed by FRAX2, otherwise, their assessment results were expressed by FRAX1.

Type 2 diabetic men had higher average weight and BMI, and greater average areas of visceral and subcutaneous fat, and lower average FRAX1 (major osteoporotic fracture) than non-diabetic men (P<0.05). Type 2 diabetic women had greater average age and visceral fat area, lower femoral neck and total hip BMD, and higher average FRAX1 (hip osteoporotic fracture) and FRAX2 (major osteoporotic fracture) and FRAX2 (hip osteoporotic fracture) than non-diabetic women (P<0.05). After adjusting for age and weight, total hip BMD in type 2 diabetic women were lower than those in non-diabetic women (P<0.05). Pearson correlation analysis results showed that visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, BMD at lumbar spine, femoral neck and total hip in non-diabetic men and postmenopausal women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in non-diabetic women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, lumbar spine BMD and total hip BMD in T2DM men (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in women or postmenopausal women with T2DM (P<0.05). Partial correlation analysis results showed that after adjusting for age and weight, visceral fat area was negatively correlated with femoral neck BMD, and total hip BMD in T2DM women (P<0.05). Visceral fat area was negatively correlated with femoral neck BMD, but positively correlated with FRAX1 (hip osteoporotic fracture) or FRAX2 (hip osteoporotic fracture) in T2DM postmenopausal women (P<0.05) .

T2DM patients had higher weight, BMI and visceral fat area than those without diabetes. T2DM women had lower femoral neck BMD and hip BMD, and may be at higher risk of 10-year hip osteoporotic fracture. Visceral fat area was negatively correlated with femoral neck BMD and total hip BMD in T2DM women. The risk of 10-year hip osteoporotic fracture may increase as visceral fat area increases in postmenopausal women with or without T2DM.

To compare the predictive value of shock index (SI), age shock index (ASI) and modified shock index (MSI) in the stratification of adverse outcomes in patients with AGB.

A retrospective design was used. Participants with AGB were selected from Department of Emergency, Hainan General Hospital from 2019 to 2020. Vital signs and calculated SI, ASI and MSI of patients were collected by the triage nurse, and their predictive values for the admission to the ICU, blood transfusion, endoscopic/colonoscopy (E/C) intervention and death were comparatively analyzed.

Altogether, 302 cases were enrolled. Among them, 158 (52.32%) had at least one adverse outcome, 38 (12.58%) were admitted to the ICU, 136 (45.03%) received blood transfusion, 54 (17.88%) received E/C intervention, and 12 (3.97%) died. The average SI, ASI and MSI of patients with adverse outcomes were all higher than those without (P<0.05). SI, ASI and MSI were all of statistical significance in predicting the adverse outcomes (P<0.05). Specifically, ASI had a larger AUC than SI (P=0.013) and MSI (P=0.024) for predicting adverse outcomes in AGB, but the AUC of SI was similar to that of MSI (P=0.985). Both SI and ASI were of statistical significance in predicting theadmission to the ICU (P<0.05). SI, ASI and MSI were all of statistical significance in predicting the requirement for blood transfusion (P<0.05). SI was of statistical significance in predicting the requirement for E/C intervention (P<0.05). The cut-off point of ASI predicting adverse outcomes in AGB was 45.12. Spearman correlation analysis indicated that the number of adverse outcomes in AGB had a positive relation with SI (r_s=0.255, P=0.002), ASI (r_s=0.360, P<0.001) and MSI (r_s=0.246, P=0.002) .

ASI is easy to be calculated during the triage phase, and it may be superior to both SI and MSI in terms of predicting adverse outcomes in AGB.

To investigate the effects of different exercise modalities on metabolic indices and pregnancy outcomes in GDM patients, providing a reference for choosing an appropriate exercise modality for GDM patients.

Two hundred and ten GDM patients were recruited from the First Affiliated Hospital of Guangxi Medical University and the Second Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020. By use of a random number sequence generated in Excel, they were equally divided into aerobic training (AT) group (moderate-intensity walking), resistance training (RT) group (lifting dumbbell while sitting) and RT+AT group (moderate-intensity walking plus lifting dumbbell while sitting). Metabolic indices were measured at baseline, 1 and 3 months after the intervention, and at delivery, respectively, including fasting blood glucose (FBG), two-hour postprandial blood glucose (2 hPBG), glycosylated hemoglobin (HbA_1c), body weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Pregnancy outcomes were also observed.

AT group, RT group and RT+AT group finally completed the test in 65 cases, 64 cases and 62 cases. (1) Significant decreases were found in average levels of FBG, 2 hPBG, SBP, and DBP in all groups at 1 and 3 months post-intervention (P<0.05). The average level of HbA_1c in RT and RT+AT groups showed a successive decrease over the period from baseline to 1, and 3 months post-intervention (P<0.05). The average level of DBP also demonstrated a successive decrease in these two groupsover the period from baseline to 1, and 3 months post-intervention (P<0.05). The average levels of 2 hPBG and HbA_1c in RT+AT group were lower than those of other two groups at 3 months post-intervention (P<0.05). (2) The average gestational age, incidence of preterm delivery and pregnancy-induced hypertension, number of insulin users, and average weight gain in late pregnancy showed no significant intergroup differences (P>0.05). The incidence of cesarean delivery in RT+AT group was lower than that of other two groups, the average amount of postpartum bleeding in RT and RT+AT groups were lower than that of AT group (P<0.05). (3) The average neonatal birth weight and length, and 1-minute Apgar score had no significant intergroup differences (P>0.05). The incidence of macrosomia varied significantly accross the groups (P<0.05). In particular, RT+AT group had a lower incidence of macrosomia than AT group (P<0.05) .

All of AT, RT and RT plus AT could improve the metabolic indices of GDM patients, but RT plus AT may be more effective. Furthermore, RT plus AT may also be more effective in improving maternal and infant outcomes of GDM patients.

To quantitatively assess pelvic floor structure and function changes and SUI, and to determine the ultrasonic diagnostic indices and threshold values for SUI in the early postpartum period in parturients of advanced maternal age using 2D and 3D ultrasound and real-time shear wave elastography (SWE) of the pelvic floor.

Participants were 194 puerperants who received ambulatory services in the early postpartum period (within the first 6-8 weeks after childbirth) from North China University of Science and Technology Affiliated Hospital from August 2016 to February 2021, including 105 of advanced maternal age (≥35 years old) and 89 of proper maternal age (<35 years old). SUI was determined by medical history, physical examination, urination diary and urodynamic test results and clinical diagnosis. Intergroup comparisons were conducted in terms of the detection rate of SUI, and parameters of 2D and 3D ultrasound and real-time SWE of the pelvic floor〔bladder neck position at rest (h_1BL) and tension (h_2BL), degree of mobility of bladder neck (Δh_BL), urethral inclination angle at rest (UIA₁) and tension (UIA₂), and urethral rotation angle (URA), posterior vesicourethral angle at rest (PVUA₁) and tension (PVUA₂), levator ani hiatus area at rest (LHA₁) and tension (LHA₂), elastic modulus of puborectal muscle in resting (E₁) and anal constriction state (E₂), and the difference between E₁ and E₂ (ΔE) 〕. The above-mentioned multimodal ultrasound parameters were also compared between those with SUI (n=51) and without (n=54) in the advanced maternal age group. The performance of multimodal ultrasound parameters in predicting early postpartum SUI was analyzed using the analysis of the area under the receiver operating characteristic curve (AUC), and was estimated with the accuracy of clinical diagnosis as the gold standard.

Compared to parturients of proper maternal age, those of advanced maternal age had higher h_1BL, h_2BL, Δh_BL, PVUA₁, and LHA₂, and lower bilateral E₁, E₂, and ΔE (P<0.05). Moreover, they had higher detection rate of SUI〔48.6% (51/105) vs 32.6% (29/89) 〕 (χ²=5.081, P=0.028). Parturients of advanced maternal age with SUI had greater h_1BL, h_2BL, Δh_BL, UIA₂, URA, PVUA₁, PVUA₂, LHA₁, LHA₂, and less bilateral E₁, E₂, and ΔE than those without (P<0.05). For parturients of advanced maternal age, the analysis of the receiver operating characteristic curve of multimodal ultrasound parameters predicting early postpartum SUI revealed that the AUC for h_1BL, h_2BL, Δh_BL, PVUA₁, PVUA₂, LHA₁, LHA₂, bilateral E₂, or bilateral ΔE was greater than 0.700. In particular, the AUC was greater than 0.850 for h_1BL (-2.28 cm optimal cutoff, 82.4% sensitivity, 90.2% specificity), h_2BL (-0.50 cm optimal cutoff, 83.3% sensitivity, 85.2% specificity), LHA₁ (16.79 cm² optimal cutoff, 94.1% sensitivity, 90.2% specificity), or bilateral ΔE (16.85 kPa optimal cutoff, 88.9% sensitivity, 87.0% specificity). Binary Logistic regression analysis of PRESUI=-3.691×h_2BL-0.952×LHA₁+0.675×bilateral ΔE, an algorithm with three ultrasound parameters incorporated for predicting SUI in parturients of advanced maternal age, indicated that the AUC of h_2BL in combination with LHA₁ and bilateral ΔE was 0.992〔95%CI (0.982, 0.999) 〕, with 0.571 optimal cutoff, 96.1% sensitivity and 96.3% specificity.

The early postpartum pelvic floor structure of parturients of advanced maternal age, especially those with SUI, was more relaxed than that of those of proper maternal age. Multimodal ultrasound can quantitatively evaluate the changes of early postpartum pelvic floor structure and function in parturients of advanced maternal age. h_1BL, h_2BL, LHA₁, bilateral ΔE or the combination of h_2BL, LHA₁ and bilateral ΔE could be used as an ultrasonic predictor of early postpartum SUI in this group, and the latter has higher diagnostic value.

To examine the overall and sex-specific associations between MHR and HUA, to assess the predictive value of HUA for HUA.

The demographic and 2020 physical examination data of 12 305 subjects over 50 years old〔5 498 men (44.7%) and 6 807 women (55.3%) 〕 from Laogang community of Shanghai's Pudong New Area were analyzed retrospectively. HUA was defined as serum uric acid level > 360 μmol/L in women, and >420 μmol/L in men. Multivariate Logistic regression was used to examine the association between MHR and HUA in all participants, and in men and women, respectively.

The prevalence of HUA in all participants, men and women was 15.8% (1 948/12 305), 17.7% (974/5 498), and 14.3% (974/6 807), respectively. After adjusting for confounding factors, monocyte〔male, OR=2.010, 95%CI (1.265, 3.194) ; female, OR=5.427, 95%CI (3.059, 9.627) 〕 and MHR〔male, OR=1.918, 95%CI (1.111, 3.313) ; female, OR=6.073, 95%CI (2.984, 12.358) 〕 were independently associated with HUA in both men and women (P<0.05) .

MHR was independently associated with HUA in men and women, and the association was stronger in women.

To explore hypoglycemic effectsof low-dose subcutaneous versus insulin infusion with a pumpin the treatment of non-comatose hyperglycemic crisis.

One hundred and fifteen hyperglycemic crisis inpatients〔72 with diabetic ketoacidosis (DKA), and 43 with hyperosmolar hyperglycemic syndrome (HHS) 〕 were selected from Guangzhou Red Cross Hospital from March 2017 to March 2020, and divided into low-dose subcutaneous insulin infusion with a pump (n=58) and low-dose intravenous insulin infusion with a pump (n=57) using random number table, treated with recombinant human insulin, and insulin aspart, respectively. Both groups were treated by a continuous low-dose insulin infusion of 0.10-0.15 U·kg^-1·h^-1 before meeting the glycemic targets. The speed of blood glucose reduction, time to reach the glycemic targets, average blood glucose and frequency of hypoglycemia were observed in both groups.

The speed of blood glucose reduction, time to reach the glycemic targets, average blood glucose and frequency of hypoglycemia demonstrated no significant differences in both groups (P>0.05). These four indicators also showed no notable differences in DKA patients in both groups (P>0.05). Furthermore, theyhad no obvious differences in HHS patients in both groups (P>0.05) .

In patients with non-comatose hyperglycemic crisis, eitherlow-dose subcutaneous or insulin infusion with a pump could effectively lower the blood glucose, and the former could be used as an alternative for hyperglycemic crisis.

To explore the clinical characteristics of peptic ulcer bleeding, and the potential risk factors of bleeding and rebleeding associated with high-risk peptic ulcer in Tibet.

A total of 212 hospitalized patients who visited the Tibet Autonomous Region People's Hospital for upper gastrointestinal bleeding and were clearly diagnosed as peptic ulcer bleeding by gastroscopy from 2017 to 2020 were selected. Patients were divided into two groups according to the Forrest classification under endoscopy: high-risk group (Ⅰa-Ⅱb) and low-risk group (Ⅱc and Ⅲ). The high-risk group was further divided into rebleeding subgroup and non-rebleeding subgroup according to the occurrence of rebleeding. The general data and clinical characteristics of the patients were analyzed, and multivariate Logistic regression analysis was used to explore the influencing factors of the high risk of peptic ulcer bleeding.

Among 212 patients with peptic ulcer bleeding, the male-to-female ratio was 5.42∶1; including 125 cases (59.0%) with gastric ulcer bleeding, 87 cases (41.0%) with duodenal ulcer bleeding; 86 (40.6%) patients in the high-risk group, and 126 (59.4%) in the low-risk group. There were 12 (14.0%) patients in the rebleeding subgroup, and 74 (86.0%) in the non-rebleeding subgroup. The hemoglobin level (HGB), urea nitrogen (BUN), the rebleeding rate and the length of hospital stay in high-risk group were higher than low-risk group (P<0.05). Multivariate Logistic regression analysis showed that HGB〔OR=1.007, 95%CI (1.001, 1.014), P=0.028〕 and BUN〔OR=1.061, 95%CI (1.003, 1.121), P=0.037〕 were the independent influencing factors for the high-risk peptic ulcer bleeding. The platelet count (PLT) and the albumin level (ALB) in the rebleeding subgroup were lower than non-rebleeding subgroup (P<0.05) .

The incidence of peptic ulcer bleeding in men was higher than women, and the incidence of peptic ulcer bleeding of gastric ulcer was higher than duodenal ulcer in Tibet. HGB and BUN level at admission were the independent influencing factors of high-risk peptic ulcer bleeding. PLT and ALB level at admission might be the risk factors of high-risk peptic ulcer rebleeding.