Introduction: Diabetic ketoacidosis (DKA) is a common complication of type 1 diabetes mellitus (T1DM). Neurological complications of DKA are rare in adults. We report a case of young lady with T1DM who presented with severe DKA and complicated with subarachnoid hemorrhage (SAH). Case: A 19-year-old female was diagnosed with T1DM following an admission for DKA 2 months earlier. Her hemoglobin A1c was 17.2%, and autoimmune markers showed positive anti-glutamic acid decarboxylase (anti-GAD) antibodies (71 IU/mL) with negative anti-insulinoma-associated antigen 2 (anti-IA2) and islet cell antibodies. Her C-peptide level was low at 69 pmol/L. She was discharged with basal bolus insulin analogues, but she defaulted on her medications. She presented to the hospital 2 months later with a history of epigastric pain, vomiting, and breathlessness for 2 days, and was then found unconscious at home. There was no history of trauma. She was intubated for a poor Glasgow Coma Scale (E1V1M1). Blood results showed severe DKA with glucose 25 mmol/L, blood gas pH 6.572, bicarbonate 2.6 mmol/L, and ketone more than 8.8 mmol/L. She was started on insulin infusion and fluid resuscitation. DKA resolved after 24 hours. Computed tomography (CT) of the brain showed SAH in the right frontal and left frontotemporal regions. CT angiography of the brain reported no evidence of an intracranial aneurysm. She was extubated on day 4 of admission. Subsequent cerebral digital subtraction angiography was unremarkable. The patient achieved complete neurological recovery on follow-up. Conclusion This case highlights that severe DKA may rarely be associated with spontaneous SAH, which increases morbidity and mortality. Proposed mechanisms include vascular injury, oxidative stress from severe ketoacidosis, and endothelial dysfunction related to inflammatory mediators. Clinicians should have a high suspicion and consider neuroimaging in DKA patients with unexplained reduced consciousness or atypical neurological findings.

This study was aimed at understanding the relationships among the drug resistance and genome characteristics of group A Streptococcus in Jiangsu Province.A total of 149 group A Streptococcus strains were collected from hospitals between 2016 and 2023.Thirteen antimicrobial minimal inhibitory concentrations were detected with the micro-dilution broth method.The GAS strains were typed with emm genotyping analysis and whole genome sequencing,to determine the carriage rates of drug resistance genes and the evolutionary relationships among strains.The resistance rates of 149 GAS strains to erythromy-cin,tetracycline,and clindamycin exceeded 90％,whereas the strains showed sensitivity to 8 different antibiotics,including penicillin.Notably,the resistance rates to erythromycin,tetracycline,and clindamycin consistently increased over time.All strains were classified into 9 emm types,among which emm12 accounted for the highest proportion(77/149;51.68％).Signifi-cant statistical differences were observed among emm types,in terms of the drug resistance rate,number of resistant species,and prevalence of drug resistance genes.Furthermore,SNP evolutionary tree analysis revealed 3 distinct clusters within the GAS strains:emm12,emm1,and other emm types.emm 12 and emm1 were the dominant GAS strains in Jiangsu Province.Most isolates were resistant to erythromycin,tetracycline,and clindamycin.Differences in phenotypes and genomic characteris-tics were observed among emm types.

Objective To explore the alterations in the numbers of cortical neurons and synapses in type 1 diabetic rats and their correlation with cognitive dysfunction.Methods A type 1 diabetes model was induced by intraperitoneal injection of streptozotocin(STZ).Four-month-old specific pathogen-free(SPF)-grade Sprague-Dawley(SD)rats were randomly allocated into a control group and a diabetic group,with five rats in each group.After three months of continuous feeding,optical fractionator stereology was employed to quantitatively analyze the volume of the cerebral cortex,the number of neurons,and the number of synapses.Results In comparison with the control group,the volume of the cerebral cortex in the diabetic group decreased by 6.00%,and the number of neurons decreased by 14.09%.However,these differences were not statistically significant(P>0.05).Never the-less,the density of synapses significantly decreased by 70.14%(P<0.05),and there was a significant difference in the number of Spinophilin/Neurabin-positive synaptic boutons per neuron in the cortex(P<0.05).Conclusion Although early-stage type 1 diabetes does not lead to a significant loss of cortical neurons,the substantial reduction in synaptic numbers might be a crucial pathological basis for cognitive dysfunction.

This study was aimed at understanding the relationships among the drug resistance and genome characteristics of group A Streptococcus in Jiangsu Province.A total of 149 group A Streptococcus strains were collected from hospitals between 2016 and 2023.Thirteen antimicrobial minimal inhibitory concentrations were detected with the micro-dilution broth method.The GAS strains were typed with emm genotyping analysis and whole genome sequencing,to determine the carriage rates of drug resistance genes and the evolutionary relationships among strains.The resistance rates of 149 GAS strains to erythromy-cin,tetracycline,and clindamycin exceeded 90％,whereas the strains showed sensitivity to 8 different antibiotics,including penicillin.Notably,the resistance rates to erythromycin,tetracycline,and clindamycin consistently increased over time.All strains were classified into 9 emm types,among which emm12 accounted for the highest proportion(77/149;51.68％).Signifi-cant statistical differences were observed among emm types,in terms of the drug resistance rate,number of resistant species,and prevalence of drug resistance genes.Furthermore,SNP evolutionary tree analysis revealed 3 distinct clusters within the GAS strains:emm12,emm1,and other emm types.emm 12 and emm1 were the dominant GAS strains in Jiangsu Province.Most isolates were resistant to erythromycin,tetracycline,and clindamycin.Differences in phenotypes and genomic characteris-tics were observed among emm types.

BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia in the elderly. This study aimed to evaluate urban-rural disparities in its prevalence and management in elderly Chinese. METHODS: Consecutive participants aged ≥ 65 years attending outpatient clinics were enrolled for AF screening using handheld single-lead electrocardiogram (ECG) from April 2017 to December 2022. Each ECG rhythm strip was reviewed from the research team. AF or uninterpretable single-lead ECGs were referred for 12-lead ECG. Primary study outcome comparison was between rural and urban areas for the prevalence of AF. The Student's t-test was used to compare mean values of clinical characteristics between rural and urban participants, while the Pearson's chi-square test was used to compare between-group proportions. Multivariate stepwise logistic regression analysis was performed to estimate the association between AF and various patient characteristics. RESULTS: The 29,166 study participants included 13,253 men (45.4%) and had a mean age of 72.2 years. The 7073 rural participants differed significantly (P ≤ 0.02) from the 22,093 urban participants in several major characteristics, such as older age, greater body mass index, and so on. The overall prevalence of AF was 4.6% (n = 1347). AF was more prevalent in 7073 rural participants than 22,093 urban participants (5.6% vs. 4.3%, P < 0.01), before and after adjustment for age, body mass index, blood pressure, pulse rate, cigarette smoking, alcohol consumption and prior medical history. Multivariate logistic regression analysis identified overweight/obesity (OR = 1.35, 95% CI: 1.17-1.54) in urban areas and cigarette smoking (OR = 1.62, 95% CI: 1.20-2.17) and alcohol consumption (OR = 1.42, 95% CI: 1.04-1.93) in rural areas as specific risk factors for prevalent AF. In patients with known AF in urban areas (n = 781) and rural areas (n = 338), 60.6% and 45.9%, respectively, received AF treatment (P < 0.01), and only 22.4% and 17.2%, respectively, received anticoagulation therapy (P = 0.05). CONCLUSIONS In China, there are urban-rural disparities in AF in the elderly, with a higher prevalence and worse management in rural areas than urban areas. Our study findings provide insight for health policymakers to consider urban-rural disparity in the prevention and treatment of AF.

INTRODUCTION: Degenerative mitral stenosis (DMS) is frequently cited as increasing in prevalence in the developed world, although comparatively little is known about DMS in comparison to rheumatic mitral stenosis (RMS). METHOD: A retrospective observational study was conducted on 745 cases of native-valve mitral stenosis (MS) with median follow-up time of 7.25 years. Clinical and echocardiographic parameters were compared. Univariate and multivariate Cox regression analyses were performed for a composite of all-cause mortality and heart failure hospitalisation. RESULTS: Patients with DMS compared to RMS were older (age, mean ± standard deviation: 69.6 ± 12.3 versus [vs] 51.6 ± 14.3 years, respectively; P<0.001) and a greater proportion had medical comorbidities such as diabetes mellitus (78 [41.9%] vs 112 [20.0%], P<0.001). The proportion of cases of degenerative aetiology increased from 1.1% in 1991-1995 to 41.0% in 2016-2017. In multivariate analysis for the composite outcome, age (hazard ratio [HR] 95% confidence interval [CI] of 1.032 [1.020-1.044]; P<0.001), diabetes mellitus (HR 1.443, 95% CI 1.068-1.948; P=0.017), chronic kidney disease (HR 2.043, 95% CI 1.470-2.841; P<0.001) and pulmonary artery systolic pressure (HR 1.019, 95% CI 1.010- 1.027; P<0.001) demonstrated significant indepen-dent associations. The aetiology of MS was not independently associated with the composite outcome. CONCLUSION DMS is becoming an increasingly common cause of native-valve MS. Despite numerous clinical differences between RMS and DMS, the aetiology of MS did not independently influence a composite of mortality or heart failure hospitalisation.
Humans ; Mitral Valve Stenosis/etiology* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Rheumatic Heart Disease/mortality* ; Echocardiography ; Hospitalization/statistics & numerical data* ; Heart Failure/epidemiology* ; Singapore/epidemiology* ; Proportional Hazards Models ; Diabetes Mellitus/epidemiology*

Objective To explore the alterations in the numbers of cortical neurons and synapses in type 1 diabetic rats and their correlation with cognitive dysfunction.Methods A type 1 diabetes model was induced by intraperitoneal injection of streptozotocin(STZ).Four-month-old specific pathogen-free(SPF)-grade Sprague-Dawley(SD)rats were randomly allocated into a control group and a diabetic group,with five rats in each group.After three months of continuous feeding,optical fractionator stereology was employed to quantitatively analyze the volume of the cerebral cortex,the number of neurons,and the number of synapses.Results In comparison with the control group,the volume of the cerebral cortex in the diabetic group decreased by 6.00%,and the number of neurons decreased by 14.09%.However,these differences were not statistically significant(P>0.05).Never the-less,the density of synapses significantly decreased by 70.14%(P<0.05),and there was a significant difference in the number of Spinophilin/Neurabin-positive synaptic boutons per neuron in the cortex(P<0.05).Conclusion Although early-stage type 1 diabetes does not lead to a significant loss of cortical neurons,the substantial reduction in synaptic numbers might be a crucial pathological basis for cognitive dysfunction.