Objective To investigate the influencing factors for neurological function recovery in patients with acute cerebral infarction(ACI)and type 2 diabetes mellitus(T2DM).Methods A total of 156 patients with ACI(ACI group)and 266 patients with T2DM combined with ACI(T2DM+ACI group)hospitalized in our hospital were enrolled in this study from December 2016 to February 2020.The recovery degree in two weeks was evaluated according to the modified Rankin scale(m-RS)score in T2DM combined with ACI.The T2DM+ACI group was further divided into a good subgroup with a score of<1(n=50)and a poor subgroup with a score of≥1(n=216).Clinical characteristics were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between m-RS score and other indicators.Multiple linear regression analysis was used to analyze the influencing factors for m-RS score.Results The levels of FPG,HbA1c and TG were higher in T2DM+ACI group than in ACI group(P<0.05).The poor subgroup had significantly higher age and LP(a)than the good subgroup(P<0.05),and significantly lower LDL-C,TG,and serum uric acid than the good subgroup(P<0.05).Pearson correlation analysis showed that m-RS score was positively correlated with age,sex and LP(a)(r=0.227,0.170,0.157;P=0.000,0.005,0.011).Multiple linear regression analysis showed that age and LP(a)were the influencing factors for m-RS score.Conclusions LP(a)a is a influencing factor for neurological function recovery in patients with T2DM combined with ACI,and clinical attention should be paid to the level of LP(a)a in such patients.

Objective To explore the influencing factors forcerebral small vessel disease(CSVD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 160 patients with T2DM admitted to the Department of Endocrinology our hospital were enrolled in this study from January 2024 to March 2024,and divided into simple T2DM group(n=107)and T2DM combined with CSVD(CSVD,n=53)group according to the combination of CSVD.The general information and biochemical indicators were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors for CSVD in patients with T2DM,and ROC curve was used to evaluate the diagnostic efficacy of CSVD markers.Results The CSVD group showed significantly higher values than the T2DM group(P<0.05)in the following parameters:DM duration,serum uric acid,cystatin C(CysC),neutrophils,monocytes,C-RP,monocyte-to-high-density lipoprotein cholesterol ratio(MHR),and PAC-1 levels.Conversely,the CSVD group had significantly lower levels of LDL-C,lymphocytes,and albumin-to-globulin ratio(A/G)compared to the T2DM group(P<0.05).Logistic regression analysis indicated that A/G,CysC,MHR,and DM duration were influencing factors for T2DM complicated with CSVD.Receiver operating characteristic(ROC)curveanalysis demonstrated that the combined prediction model incorporating A/G,CysC,MHR,and DM duration yielded an area under the curve of 0.88,indicating good predictive performance.Conclusions A/G,CysC,MHR,and duration are independent risk factors for CSVD in patients with T2DM.Early identification of these items may facilitate the prevention of CSVD in patients with T2DM.

Objective To investigate the inhibitory effect of running combined with chitosan on high-fat diet(HFD)induced obesity in rats through the expression of fatty acid transporter 4(FATP4)and Toll like receptor 4(TLR4)and its mechanism.Methods 50 male Wistar rats were randomly divided into normal control(NC)group,HFD group,chitosan(Chi)group,running exercise(Run)and chitosan+running exercise(Chi+Run)group,with 10 rats in each group.The levels of serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),very low density lipoprotein cholesterol(VLDL-C),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were detected.ELISA was used to detect serum TNF-α,IL-6,APN,Ghrelin,Leptin(LP),and Ins levels.Western blot was used to test the expression of FATP4 and TLR4 proteins in liver and adipose tissue,and HE staining was used to evaluate liver and adipose tissue pathology.Results Compared with the HFD group,the Chi,Run,and Chi+Run groups showed an increase in HDL-C,serum APN,and Ghrelin(P<0.05),as well as an decreased in body weight,fat mass,obesity index,TC,TG,LDL-C,VLDL-C,ALT,AST,TNF-α,IL-6,LP,Ins,FATP4 protein expression,TLR4 protein expression,adipocyte size and quantity in liver and adipose tissue(P<0.05).The HDL-C was higher in Chi+Run group than in Chi and Run groups(P<0.05),and the final weight,LDL-C,TG,AST,IL-6,the expression of FATP4 protein,TLR4 protein,and adipocyte size in the liver and adipose tissue were lower in Chi+Run group than in Chi and Run groups(P<0.05).Conclusions The inhibitory effect of running combined with Chi on HFD induced obesity was superior to that of running or Chi alone,and its mechanism may be related to the downregulation of FATP4 and TLR4.

Objective To investigate the risk factors and establish a line graph model for diabetic retinopathy(DR)and diabetic macular edema(DME)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 446 patients with T2DM admitted to our hospital from June 2017 to January 2020 were selected and divided into DR/DME group(n=80)and T2DM group(n=366)according to whether they were complicated with DR and DME.Univariate and multivariate analysis were performed on the clinical data to obtain the influencing factors,and a nomogram model was constructed to evaluate the model.Results The DM duration,proportion of short axial length,FPG,HbA1c,TC and LDL-C in the DR/DME group were higher than those in the T2DM group,and the age and eGFR were lower than those in the T2DM group(P<0.05).DM duration(OR 16.380,95%CI 10.697～29.133),eGFR(OR 13.510,95%CI 5.393～33.863),HbA1c(OR 2.820,95%CI 1.064～5.610)and short axial length(OR 7.062,95%CI 1.153～43.265)were the influencing factors of DR and DME in T2DM patients.The AUC of the nomogram model was 0.906.The consistency index(0.957)and calibration curve showed that the model had good discrimination and consistency.Conclusions The DM duration,eGFR,HbA1c and short eye axis are closely related to DR and DME in T2DM patients,and the column line graph model based on this analysis has high predictive efficacy.

Objective To analyze the difference of serum Irisin in patients with type 2 diabetes mellitus(T2DM)and different degrees of arteriosclerosis lower extremity,and explore the relationship between irisin and inflammatory response.Methods A total of 120 patients with T2DM admitted to our hospital from June 2020 to June 2023 were enrolled in this study.All the patients were divided into simple T2DM group(n=32,0.9≤ABI<1.4),mild arteriosclerosis lower extremity group(MIA,n=49,0.7≤ABI<0.9),moderate arteriosclerosis lower extremity group(MOA,n=26,0.5≤ABI<0.7),and severe arteriosclerosis lower extremity group(SA,n=13,ABI<0.5)according to the patients'ankle brachial index(ABI).The relationship between serum Irisin and inflammatory response and the effect on the degree of arteriosclerosis of lower limbs were analyzed.Results Multivariate Logistic regression analysis showed that HbA1c,serum Irisin,hs-CRP,TNF-α,CysC and LP-PLA2 were independent influencing factors for severe arteriosclerosis lower extremity.Spearman correlation analysis showed that ABI was positively correlated with Irisin(P<0.05),and negatively correlated with hs-CRP,TNF-α,CysC and LP-PLA2(P<0.05).Restricted cubic spline analysis showed that serum Irisin was negatively correlated with severe arteriosclerosis lower extremity(P<0.05).Mediation effect model analysis showed that hs-CRP(β=0.149,95%CI 0.126～0.183),TNF-α(β=0.115,95%CI 0.096～0.147),CysC(β=0.096,95%CI 0.078～0.132),LP-PLA2(β=0.197,95%CI 0.166～0.214)all played a mediating effect between serum Irisin and the degree of arteriosclerosis of lower limbs.Conclusions The degree of lower extremity arteriosclerosis is negatively correlated with serum Irisin level in patients with T2DM,which reduces the risk of disease exacerbation by inhibiting inflammatory response.

[Summary]Diabetic kidney disease(DKD)caused a huge medical burden to society and has become an increasingly serious public health problem.Different from steroidal mineralocorticoid receptor antagonist,Finerenone,as a new non-steroidal mineralocorticoid receptor antagonist,has higher selectivity and effectiveness.It can effectively delay the progression of DKD through anti-inflammatory and anti-fibrosis effects,reduce urinary protein,and has a low incidence of hyperkalemia and a cardioprotective effect.This article summarizes the benefits of Finerenone in DKD,its advantages over other mineralocorticoid-receptor antagonists,and its efficacy in combination with other drugs for the treatment of DKD.

[Summary]Diabetic retinopathy is the most common diabetic microvascular complication and the leading cause of vision loss in adults.Mitochondrial quality control regulates the quality and quantity of mitochondria through a series of processes to maintain mitochondrial function and homeostasis.These processes include mitochondrial biogenesis,mitochondrial dynamics and mitochondrial autophagy,abnormalities of which can lead to mitochondrial dysfunction.Current studies have shown that mitochondrial dysfunction is associated with a variety of diseases,including neurodegenerative diseases,tumors,cardiovascular diseases and diabetes.At present,there are few studies on mitochondrial dysfunction and DR.This paper reviews the literature on mitochondrial quality control and DR,discusses the possible role of mitochondrial dysfunction in the occurrence and development of DR in order to seek possible molecular therapeutic targets.

Objective To investigate the predictive value of bone metabolism parameters on cardiac autonomic nervous system function in patients with type 2 diabetes mellitus(T2DM).Methods A total of 328 patients with T2DM hospitalized in the Department of Endocrinology of Gansu Provincial People's Hospital were enrolled in this study from October 2022 to October 2023.According to the serum 25(OH)D level,all the participants were divided into<10 ng/ml group(n=80),10～20 ng/ml group(n=173),and 20～30 ng/ml group(n=75).Biochemical indicators,bone metabolic parameters,left ventricular mass(LVM)and left ventricular mass index(LVMI)were compared.Time domain indicators ofheart rate variability(HRV)in 24 h holter electrocardiogram,including the global standard deviation of normal sinus RR interval(SDNN),sinus RR interval mean standard deviation(SDANN),and normal continuous sinus RR interval difference root mean square(RMSSD).Meanwhile,adjacent RR interval difference>50 ms as a percentage of the total inter-period(PNN50),HRV triangle index,standard deviation of the difference between the length of the entire adjacent NN interperiod(SDSD),and 24 h holter electrocardiogram HRV time-domain relevant indicators were compared among the three groups.The influence of bone metabolism parameters on cardiac autonomic nervous function and their correlation were analyzed,and the optimal cutting point of cardiac autonomic nervous function was predicted by receiver operating characteristic(ROC)curve.Results SBP,heart rate(HR),FPG,PWV,PTH and β-CTX in groups of 10 ng/ml,10～20 ng/ml and 20～30 ng/ml decreased in turn(P<0.05),while HDL-C,ABI,25(OH)D,Ca2+and PNN50 decreased.Correlation analysis between Spearman and Pearson showed that 25(OH)D was positively correlated with SDNN,HRV triangle index,PNN50 and rMSSD(P<0.01).Logistic regression analysis showed that 25(OH)D,Ca2+and HR were the influencing factors of cardiac autonomic nervous dysfunction in patients with T2DM.The ROC curve analysis showed that the areas under the ROC curve of 25(OH)D,Ca2+and HR were 0.791,0.607 and 0.629,respectively,with sensitivity of 73.4%,53.2%and 38.7%,and specificity of 74.0%,93.6%and 81.4%,respectively.Conclusions 25(OH)D is the influencing factor of cardiac autonomic nervous dysfunction in patients with T2DM,and patients with high degree of deficiency are more prone to cardiac autonomic nervous dysfunction.

Objective To investigate the correlation between skeletal muscle fat content and diabetic peripheral neuropathy(DPN)in patients with type 2 diabetes mellitus(T2DM).Methods 290 patients with T2DM admitted to our hospital were enrolled in this study from January 2023 to February 2024 and divided into two groups according to whether they were complicated with DPN:simple T2DM group(T2DM,n=98)and T2DM with DPN group(DPN,n=192).The general data,biochemical indexes and fat distribution indexes measured based on quantitative CT were compared between the two groups.Spearman correlation was used to analyze the relationship between fat distribution indexes and DPN,logistic regression analysis of influencing factors of T2DM complicated with DPN.Results Age,DM duration,WHR,FIns,insulin resistance index(HOMA-IR)and FF were higher in DPN group than in T2DM group(P<0.05).Ca,subcutaneous abdominal fat area(SFA)and liver fat content were lower in DPN group than in T2DM group(P<0.05).Spearman correlation analysis showed that DPN was negatively correlated with SFA and liver fat content(r=-0.127,-0.123,P<0.05),and positively correlated with FF(r=0.117,P<0.05).Logistic regression analysis showed that without adjusting for confounding factors and adjusting for DM duration,WHR,HOMA-IR,Ca,SFA and liver fat content,FF was an influential factor for DPN in T2DM patients.Conclusions Skeletal muscle FF was associated with DPN in patients with T2DM.

Objective To explore the effect of Liraglutide(Lir)combined with intravenous thrombolysis on neurological function and prognosis in acute cerebral infarction patients with type 2 diabetes mellitus(T2DM).Methods Totally 137 acute cerebral infarction patients with T2DM were randomly divided into Lir group(69 cases)and Ins group(68 cases).The Ins group was treated with insulin aspart combined with insulin glargine,while the Lir group was treated with Lira combined with insulin glargine.The scores of National Institutes of Health stroke scale(NIHSS)and modified Rankin scale(mRS)were compared between the two groups before and 3 months after treatment.Outpatient follow-up of the two groups was performed to record the recurrence of cerebral infarction and the time.Results After treatment,the scores of NIHSS[(6.51±1.91)vs(8.77±2.03)]and mRS[(2.07±0.58)vs(2.44±0.78)]of Lir group were lower than Ins group(P<0.05).The recurrence risk of cerebral infarction in Lir group was lower than that in Ins group(6.5%vs 22.1%,P<0.05).Conclusions The treatment of Lir combined with intravenous thrombolysis can effectively reduce neurological deficits and the recurrence risk in acute cerebral infarction patients with T2DM.