Effects of lifestyle interventions on rural patients with type 2 diabetes mellitus

BACKGROUND The prevalence of type 2 diabetes mellitus(T2DM)is rising rapidly in rural areas,and lifestyle interventions can effectively reduce the blood glucose levels of patients with T2DM.However,current dietary and exercise guidelines are still at experimental stages and are difficult for subjects to understand and implement.The Human Metabolism Analyzer provides real life interventions for the prevention and treatment of T2DM,and our pilot research has demonstrated its effectiveness and good compliance.AIM To investigate the effect of and compliance with lifestyle interventions in rural patients with T2DM.METHODS A total of ten rural villages were randomly selected in Chaoshui Township,Penglai City,Shandong Province,China,to conduct health screening among residents aged 50 years or older.Each rural village represented a group,and 12 patients with T2DM were randomly selected from each group(total:120)to participate in this study and receive real life lifestyle interventions and medication guidance.Lifestyle interventions included changing the meal order(A),postprandial activities(B),resistance exercise(C),and reverse abdominal breathing(D).Diabetes education was conducted at least once a month with a weekly phone follow-up to monitor exercise and diet.Waist circumference,blood pressure,body mass index(BMI),motor function,body composition,fasting blood glucose,and glycated hemoglobin(HbA1c)were analyzed before and 3 mo after the intervention.Moreover,patient compliance and adjustments of hypoglycemic drugs were evaluated.RESULTS A total of 109 subjects completed the study.The compliance rates for lifestyle interventions A,B,C,and D were 57.79%,60.55%,64.22%,and 75.23%,respectively.Among the subjects who received hypoglycemic drugs,the dose was reduced 2 to 3 times based on blood glucose in 54(67.50%)subjects and was tapered and discontinued in 5(6.25%)subjects within 3 mo,with no significant fluctuations in blood glucose after dose reduction and withdrawal.After lifestyle interventions,waist circumference,BMI,fasting blood glucose,and HbA1c significantly decreased(P<0.001);motor function and body composition also significantly improved(P<0.001).CONCLUSION For patients with T2DM,compliance to real-life lifestyle interventions is good,and the interventions significantly improve metabolic indicators such as waist circumference,BMI,blood pressure,HbA1c,body composition,and motor function.Some patients are able to taper or discontinue hypoglycemic drugs.

Surgical complexity and prognostic outcome of small volume renal cell carcinoma with high-level venous tumor thrombus and large volume renal cell carcinoma with low-level thrombus

Background:Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations.But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear.This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.Methods:The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed.Among these 67 cases,21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level Ⅱ-Ⅳ),while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0-Ⅰ).Clinical features,operation details,and pathology data were collected.Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.Results:Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs.282.2 ± 101.9 min,t=4.685,P < 0.001),more surgical bleeding volume (1200 [325,2900] mL vs.500 [180,1000] mL,U =270.000,P =0.004),more surgical blood transfusion volume (800 [0,1400] mL vs.0 [0,800] mL,U =287.500,P =0.004),more plasma transfusion volume (0 [0,800] mL vs.0 [0,0] mL,U =319.000,P =0.004),higher percentage of open operative approach (76.2% vs.32.6%,x2 =11.015,P =0.001),higher percentage of IVC resection (33.3% vs.0%,x2 =17.122,P < 0.001),and higher percentage of post-operative complications (52.4% vs.19.6%,x2 =7.415,P =0.010) than patients with large tumors and low-level thrombus.In multivariate analysis,decreased hemoglobin (Hb)(odds ratio [OR]:0.956,95 % confidence interval [CI]:0.926-0.986,P =0.005) and non-sarcomatoid differentiation (OR:0.050,95% CI:0.004-0.664,P =0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with small tumor thrombus.The estimated mean cancerspecific survival times of small tumor with high-level thrombus and large tumor with low-level thrombus were 31.6 ± 3.8 months and 32.5 ± 2.9 months,without statistical significance (P =0.955).After univariate and multivariate Cox proportional hazard survival regression analyses,only distant metastasis (hazard ratio [HR]:3.839,P =0.002),sarcomatoid differentiation (HR:7.923,P < 0.001),alkaline phosphatase (HR:2.661,P =0.025),and severe post-operative complications (HR:10.326,P =0.001) were independent predictors of prognosis.Conclusions:The level of the tumor thrombus was more important than the diameter of the primary kidney tumor in affecting the complexity of surgery.In the same T3 stage,neither the renal tumor diameter nor the tumor thrombus level was an independent risk factor for prognosis.

Imaging predictors for assessment of inferior vena cava wall invasion in patients with renal cell carcinoma and inferior vena cava tumor thrombus:a retrospective study

Background:Renal cell carcinoma(RCC)has the propensity to lead to venous tumor thrombus(VTT).Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications.The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava(IVC)wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings.Methods:Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy(levels Ⅰ-Ⅳ)for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018.Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus.Results:Among the 110 patients,41 underwent partial or segmental resection of IVC.There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection,including those of the Mayo classification,maximum anterior-posterior(AP)diameter of the renal vein at the renal vein ostium(RVo),maximum AP diameter of the VTT at the RVo and IVC occlusion.For the multivariable analysis,the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus.The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion,with which we predicted invasions of the IVC wall requiring IVC resection.The probabilities of intra-operative IVC resection for patients without both independent factors,with an AP diameter of the VTT at the RVo larger than 17.0 mm,with IVC occlusion,and with both concurrent factors were 5%,23%,56%,and 66%,respectively.Conclusion:An increase in the AP VTT diameter at the RVo and the presence of complete occlusion of the IVC are independent risk factors for a high probability of IVC wall invasion by tumor thrombus.

Peking University Third Hospital score:a comprehensive system to predict intra-operative blood loss in radical nephrectomy and thrombectomy

Background:Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon’s experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy.Methods: The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis.Results: The final multivariable model included the following three factors: open operative approach (P < 0.001), Neves classification IV (P < 0.001), inferior vena cava resection (P = 0.001). The PKUTH score (0-3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280 mL (interquartile range [IQR] 100-600 mL), 1250 mL (IQR 575-2700 mL), 2000 mL (IQR 1250-2900 mL), and 5000 mL (IQR 4250-8000 mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P = 0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0vs. 1 to 3 (P = 0.098).Conclusion: We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.

Identification of TWIST-interacting genes in prostate cancer

Prostate cancer is one of the most common cancers in men worldwide, and the number of diagnosed patients has dramatically increased in recent years. Currently, the clinical parameters used to diagnose prostate cancer, such as Gleason score, pathological tumor staging, and prostate-specific antigen(PSA) expression level, are considered insufficient to inform recommendation to guide clinical practice. Thus, identification of a novel biomarker is necessary. TWIST is one of the well-studied targets and is correlated with cancer invasion and metastasis in several human cancers. We have investigated two largest prostate cancer patient cohorts available in GEO database and found that TWIST expression is positive correlated with Gleason score and associated with poorer survival. By using a prostate cancer cohort and a prostate cancer cell line dataset, we have identified three potential downstream targets of TWIST, PPM1 A, SRP72 and TBCB. TWIST's prognostic capacity is lost when the gene is mutated. Further investigation in the prostate cancer cohort revealed that gene expression of SERPINA, STX7, PDIA2, FMP5, GP1 BB, VGLL4,KCNMA1, SHMT2, SAA4 and DIDO1 influence the prognostic significance of TWIST and vice versa. Importantly, eight out of these ten genes are prognostic indicator by itself. In conclusion, our study has further confirmed that TWIST is a prognostic marker in prostate cancer, identified its potential downstream targets and genes that could possibly give additional prognostic value to predict TWIST-mediated prostate cancer progression.