Background: Studies reporting the status of coronary microvascular function in the infarct-related artery (IRA) after primary percutaneous coronary intervention (PCI) remain limited. This study utilized the coronary angiography-derived index of microcirculatory resistance (caIMR) to assess coronary microvascular function in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods: We used the FlashAngio system to measure the caIMR after primary PCI in 157 patients with STEMI. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite endpoint encompassing cardiac mortality, target vessel revascularization, and rehospitalization due to congestive heart failure (CHF), myocardial infarction (MI), or angina. Results: Approximately 30% of patients diagnosed with STEMI and who experienced successful primary PCI during the study period had a caIMR in the IRA of >40. The caIMR in the IRA was significantly higher than in the reference vessel (32.9 ± 15.8 vs. 27.4 ± 11.1, p < 0.001). The caIMR in the reference vessel of the caIMR >40 group was greater than in the caIMR ≤40 group (30.9 ± 11.3 vs. 25.9 ± 10.7, p = 0.009). Moreover, the caIMR >40 group had higher incidence rates of MACEs at 3 months (25.5% vs. 8.3%, p = 0.009) and 1 year (29.8% vs. 13.9%, p = 0.04), than in the caIMR ≤40 group, which were mainly driven by a higher rate of rehospitalization due to CHF, MI, or angina. A caIMR in the IRA of >40 was an independent predictor of a MACE at 3 months (hazard ratio (HR): 3.459, 95% confidence interval (CI): 1.363–8.779, p = 0.009) and 1 year (HR: 2.384, 95% CI: 1.100–5.166, p = 0.03) in patients with STEMI after primary PCI. Conclusions: Patients with STEMI after primary PCI often have coronary microvascular dysfunction, which is indicated by an increased caIMR in the IRA. An elevated caIMR of >40 in the IRA was associated with an increased risk of adverse outcomes in STEMI patients undergoing primary PCI.

Objective To investigate the clinical features of elderly patients with stage 3-4 chronic kidney disease （CKD） and to analyze the risk factors of the kidney function progression.Methods This was a cross-sectional study. The clinical data of elderly patients （≥60 years）with stable clinical manifestation in Beijing Hospital from January, 2014 to December, 2015 were collected. Based

Objective: Hemoglobin A1c (HbA1c) is routinely used to evaluate glycemic control in patients with diabetes. Using HbA1c of ≥ 6.5% for screening and diagnosis of type 2 diabetes is also recommended. The purpose of this study was to investigate seasonal variations of HbA1c in residents of Beijing city (China), including both diabetic and non-diabetic subjects. Methods: The study cohort included 61,167 HbA1c observations (HbA1c < 6.5%: n=36,174; HbA1c ≥ 6.5%: n=24,993) from residents who performed physical examination in Beijing Hospital over 5 years (from Jan 2007 to Apr 2011). We calculated monthly average HbA1c for both overall population and subpopulations defined by HbA1c values (HbA1c < 6.5% or HbA1c ≥ 6.5%). In addition, we analyzed whether there are any differences in HbA1c among subgroups divided by gender, age and time of blood specimen collection. Finally, general linear models (GLM) were applied to the data to assess the impact and potential interactions of various independent variables (age, time, month and gender) on the HbA1c changes. Results: For overall population, we observed a peak of HbA1c value (6.67%) in January and a trough (6.38%) in June to August. Surprisingly, it was noticed that the lowest value (6.36%) was in November. Similar monthly pattern was found in the subpopulations of HbA1c < 6.5%. For the subpopulations with higher values (HbA1c ≥ 6.5%), very slight changes were shown, with higher value (7.48%) in January to February and lower value (7.31%) in September. These seasonal fluctuations of monthly HbA1c values are statistically significant adjusted for all of the other factors in GLM analysis (age, time, and gender). Conclusion: In residents of Beijing, relatively higher HbA1c values in winter and lower values in summer were observed. In addition, the lowest HbA1c value was noticed in November, especially for subgroup of HbA1c < 6.5%. We think both geographical and cultural influences are directly related to HbA1c monthly variations. These findings have implications for epidemiologic studies and clinical assessment in both diabetic and non-diabetic populations.

OBJECTIVE:To analyze the impact of atorvastatin on blood lipids and arterial media thickness (IMT) in new-onset type 2 diabetes patients.METHODS:333 patients, 30-70 years old and diagnosed within one year as type 2 diabetes, were selected from the Chinese Diabetes Complication Prevention Study (CDCPS) to take part in this study. Changes of blood lipids and IMT of carotid, femoral and iliac artery pre and post the administration of atorvastatin were tested and followed for 24 months.RESULTS:Total cholesterol, triglycerides and low-density lipoprotein decreased significantly (P = 0.000) and maintained at a low level. The carotid artery IMT decreased significantly (P = 0.022) at the end of this study, but the femoral and iliac artery IMT did not show any obvious change. There were no serious adverse events noticed, during the study period.CONCLUSION:Long-term use of atorvastatin seemed to be safe and effective in reducing blood lipids in patients with type 2 diabetes thus could delay the development of atherosclerosis.

OBJECTIVE:To analyze the prevalence rate of diabetic nephropathy (DN) and the related factors on DN among type 2 diabetic patients.METHODS:A total number of 1758 type 2 diabetic patients who were hospitalized in the Beijing Hospital from 2003 to 2010 were analyzed retrospectively. Three groups were divided according to the rate of urinary albumin excretion (UAER). Patients whose UAER < 20 µg/min belonged to normal albuminuria (NA) group. The ones whose UAER from 20 to 200 µg/min belonged to microalbuminuria (MA) group, and the others whose UAER ≥ 200 µg/min belonged to large albuminuia (LA) group. The clinical characteristics were then compared. The related factors of DN were analyzed.RESULTS:(1) There were 1246 patients in NA group, 408 patients in MA group, and 104 patients in LA group. The constituent ratio of nephropathy was 29.1%. (2) The ages of NA group, MA group and LA group were (59.87 ± 12.77, 62.52 ± 12.74, 64.44 ± 12.74) years old, respectively, with body mass index (BMI) as (24.90 ± 3.42, 25.53 ± 4.00, 25.53 ± 3.91) kg/m(2) respectively; duration of diabetes as (8.39 ± 7.12, 10.77 ± 8.02, 12.84 ± 7.97) years; systolic blood pressure (SBP) as (133.42 ± 18.19, 142.72 ± 20.21, 151.12 ± 21.91) mm Hg; diastolic blood pressure as (78.75 ± 10.66, 80.79 ± 12.21, 83.33 ± 13.61) mm Hg; fasting blood sugar (FBS) as (8.25 ± 3.43, 9.02 ± 3.72, 9.22 ± 4.62) mmol/L; glycated hemoglobin (HbA1c) as (8.88 ± 2.10, 9.34 ± 2.36, 9.10 ± 2.36)%; uric acid (UA) as (288.04 ± 90.41, 307.23 ± 96.96, 374.28 ± 105.47) mmol/L; triglyceride as (1.72 ± 1.51, 2.06 ± 1.88, 1.94 ± 1.42) mmol/L, high density lipoprotein cholesterol as (1.08 ± 0.30, 1.02 ± 0.29, 1.07 ± 0.28) mmol/L; fasting insulin as (9.24 ± 9.02, 11.24 ± 9.74, 11.06 ± 9.29) µU/ml; fasting C peptide as (462.31 ± 289.94, 510.02 ± 350.08, 595.93 ± 445.86) pmol/L. There were significant differences between NA, MA and LA groups in all above items (P < 0.01 or P < 0.05). (3) Logistic regression analysis showed that DN were related with duration of diabetes, BMI, SBP, HbA1c, FBS, UA (OR values were 1.041, 1.055, 1.028, 1.116, 1.100, 1.004 respectively, P < 0.05 or P < 0.01).CONCLUSION:It would be helpful to prevent and retard progression of DN that comprehensively controlling high blood glucose, hypertension, hyperuricemia and body weight of type 2 diabetic patients.

BACKGROUND:Coronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.METHODS:A total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.RESULTS:The incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P < 0.05). The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) = 1.058, P < 0.0001, 95% confidence interval (CI): 1.036 - 1.080). Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β = 0.476, P < 0.0001). The best predictive value of urinary albumin excretion rate was 10.45 µg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively.CONCLUSIONS:The occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.

Objective To analyze the initial treatment strategies, blood glucose control and reaching standard status of newly diagnosed type 2 diabetes mellitus (T2DM) in the middle-aged and elderly. Methods The 771 patients diagnosed with T2DM newly or within one year, aged 50-70 years, selected from Chinese Diabetes Complication Prevention Study (CDCPS) were enrolled in this study. The correlations of initial treatment strategies with blood glucose control (target value of glycated hemoglobin was less than 7.0%) and reaching standard status were analyzed retrospectively. Based on the same lifestyle intervention, the therapy was further divided into group A (without medication), group B (single oral hypoglycemic agent), group C (combined oral hypoglycemic agents), group D (treatment including insulin). Results Although receiving the different treatments, the 771 patients had a similar mean glycated hemoglobin level, from 7.2% to 7.7%, among the four kinds of intervention before entering the study. The increased intensity and complexity after therapy adjustment along with the increased glycated hemoglobin level was observed at baseline. The corresponding relationships between medication and HbA1c were as follow: without medication-6.1%, single oral hypoglycemic agent-7.2%, combined oral hypoglycemic agents-7.7%, treatment including insulin-9.2%. After 20 months of follow-up, the mean fasting glucose and glycated hemoglobin were 6.6 mmol/L and 6.2%, separately. According to the target glycated hemoglobin level of less than 7.0%, all four-kinds of therapies had high achievement rates, which were all above 80% except that was 63.2% in group D. Sulphonylurea and biguanide as initial single oral hypoglycemic agent therapy had the similar effectiveness on glucose control and target glycated hemoglobin achievement. Conclusions According to the levels of glucose and glycated hemoglobin, multiple individual therapies should be enacted at the beginning of treatment. The strategy mainly based on sulphanylurea and biguanide is proved to be persistently effective in newly-diagnosed middle-aged and elderly diabetic patients in China.

After target blood glucose (HbA1C,fasting plasma glucose),serum lipid profiles (total cholesterol,triglyeeride) and control of blood pressure were achieved in 532 patients with type 2 diabetes mellitus, the level of serum uric acid was significantly decreased and the number of case of hyperuricacidemia also reduced (all P<0.01).

Objective To investigate the relationship between retinal leukocyte accumulation induced by vascular endothelial growth factor(VEGF) and blood retinal barrier breakdown in rats.Methods Twelve Brown-Norway rats were divided into control group and VEGF intravitreal injection group.After acridine orange (5 mg·kg-1) and evans blue(45 mg·kg-1) injecting through the jugular vein,the density of leukocytes and content of evans blue were detected in the retina.Results Twenty-four hours after VEGF intravitreal injection,the density of leukocytes in the retina of control group and VEGF intravitreal injection group were (1.90±0.03)×10-6 per square micrometer and (9.10±0.08)×10-6 per square micrometer,and the content of evans blue were (14.78±3.27)ng·mg-1 and(51.72±6.77)ng·mg-1.VEGF intravitreal injection groups were much higher than that of control groups(P0.01).Conclusion Retinal leukocyte accumulation induced by VEGF has relations with the increase of blood retinal barrier breakdown,which can be quantitatively detected by the methods of acridine orange fluorography and evans blue.